Epidemiology and risk factors for gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy.
The objective of this study was to evaluate the risk of acquiring gram-positive coccal infections in febrile neutropenic patients and to develop risk indexes for gram-positive and streptococcal infections. This prospective, multicenter study included 513 patients. The prevalence of gram-positive coccal infections was 21% (14% were staphylococcal infections and 7.8% were streptococcal infections). The mortality rate during the month after study enrollment was 5%. On multivariate analysis, the occurrence of gram-positive coccal infections was significantly associated with receipt of high-dose cytarabine therapy, proton pump inhibitors, and gut decontamination with colimycin without glycopeptides and presence of chills. Staphylococcal infection was significantly associated with use of nonabsorbable colimycin, and streptococcal infection was associated with diarrhea, use of nonabsorbable antifungals, receipt of high-dose cytarabine, and gut decontamination with colimycin. The relative risks for streptococcal infection were 2.9, 13.2, and 20.7 in the presence of 1, 2, and > or =3 parameters, respectively. Risk factors for staphylococcal and streptococcal infections differ among neutropenic patients. A simple scoring system for predicting streptococcal infection is proposed.
Cordonnier
Catherine
C
Hematology Department, University Paris XII, Henri Mondor Hospital, 94000 Créteil, France. carlcord@club-internet.fr
Buzyn
Agnès
A
Leverger
Guy
G
Herbrecht
Raoul
R
Hunault
Mathilde
M
Leclercq
Roland
R
Bastuji-Garin
Sylvie
S
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005334:Fever / Q000209:etiology; D006094:Gram-Positive Bacteria / Q000187:drug effects; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D009503:Neutropenia / Q000150:complications* / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
D000900:Anti-Bacterial Agents