title: Increased incidence of bacteraemia due to viridans streptococci in an unselected population of patients with acute myeloid leukaemia.
abstract: The aetiology, clinical characteristics and outcome of bacteraemia in patients with acute myeloid leukaemia were studied. All positive blood cultures collected at a haematological ward during 2 7-y periods were evaluated. Altogether, 274 episodes of bacteraemia in 152 patients were recorded, 80 episodes during 1980-86 and 194 during 1990-96. During the 2 periods, trimethoprim-sulfamethoxazol in combination with amikacin was the first-line empirical therapy in patients with neutropaenia and fever. In 1990, antimicrobial prophylaxis with ciprofloxacin and fluconazole was introduced. The incidence of bacteraemia due to viridans streptococci or coagulase-negative staphylococci increased from the first period to the second, whereas the incidence of Enterobacteriaceae decreased. In granulocytopaenic patients during 1990-96, viridans streptococci accounted for 21% of the isolates and in patients treated prophylactically with fluoroquinolone, viridans streptococci accounted for 31%. All viridans streptococci were sensitive to penicillin. At the time of the positive blood cultures, the patients of the second period were granulocytopaenic in 83% of the episodes. The mortality related to septicaemia during the later period was 13% and only 1 of 33 (3%) of the patients with viridans streptococci died. Eight patients (9%) died in relation to septicaemia following curative antileukaemic therapy.
authors.affiliation: Department of Infectious Diseases, Orebro Medical Centre Hospital, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Persson
authors.forename: T
authors.initials: T
authors.lastname: Vikerfors
authors.forename: L
authors.initials: L
authors.lastname: Sjöberg
authors.forename: P
authors.initials: P
authors.lastname: Engervall
authors.forename: U
authors.initials: U
authors.lastname: Tidefelt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D010406:Penicillins / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D013291:Streptococcus / Q000145:classification* / Q000187:drug effects; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D015725:Fluconazole