Nosocomial bloodstream infections due to viridans streptococci in haematological and non-haematological patients: species distribution and antimicrobial resistance.
OBJECTIVE
We studied the species distribution and antimicrobial susceptibility of viridans streptococci (VS) isolates causing nosocomial bloodstream infections (BSIs) in Finnish hospitals.


METHODS
Patients with nosocomial BSIs due to VS were identified through a hospital-wide prospective laboratory-based surveillance in two university and two regional hospitals during September 1998-August 2001. Isolates of VS were sent to the reference laboratory for species confirmation and antimicrobial susceptibility testing.


RESULTS
A total of 2038 nosocomial BSIs were identified; 108 (5%) of the BSIs were caused by VS. Of the VS BSIs, 66% were in patients with a haematological malignancy, 14% in patients with a solid tumour and 18% in patients who had undergone surgery preceding the infection. The most common species group identified was Streptococcus mitis (82%). High-level penicillin resistance (> or = 4 mg/L) and cefotaxime resistance (> or = 4mg/L) were present in 5% and 4% of isolates, respectively; both were detected only in haematological patients. However, in non-haematological patients, resistance to erythromycin (17%), and reduced susceptibility to levofloxacin (14%) and penicillin (19%) were common.


CONCLUSIONS
The resistance problems in VS are not limited to haematological patients. These findings may have significant clinical implications in the choice of both empirical antibiotic and antimicrobial prophylaxis regimens.
Lyytikäinen
Outi
O
Departments of Infectious Disease Epidemiology and Microbiology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki. outi.lyytikainen@ktl.fi
Rautio
Merja
M
Carlson
Petteri
P
Anttila
Veli-Jukka
VJ
Vuento
Risto
R
Sarkkinen
Hannu
H
Kostiala
Anja
A
Väisänen
Marja-Liisa
ML
Kanervo
Arja
A
Ruutu
Petri
P
D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000502:physiology*; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D034363:Viridans Streptococci / Q000187:drug effects* / Q000254:growth & development
D000890:Anti-Infective Agents