title: Fulminant sepsis caused by Bacillus cereus in patients with hematologic malignancies: analysis of its prognosis and risk factors.
abstract: Bacillus cereus is a growing concern as a cause of life-threatening infections in patients with hematologic malignancies. However, the risk factors for patients with unfavorable outcomes have not been fully elucidated. At our institution, we observed the growth of B. cereus in blood culture in 68 patients with (23) or without (45) hematologic malignancies treated from September 2002 to November 2009. We defined a case as having sepsis when more than two blood culture sets were positive for B. cereus or only a single set was positive in the absence of other microorganisms in patients who had definite infectious lesions. We determined 12 of 23 patients with hematologic malignancies as having sepsis, as well as 10 of 45 patients without hematologic malignancies (p = 0.012). Of the 12 patients with hematologic malignancies, four patients with acute leukemia died of B. cereus sepsis within a few days. In our cohort, risk factor analysis demonstrated that a neutrophil count of 0/mm(3), central venous (CV) catheter insertion, and the presence of central nervous system (CNS) symptoms were significantly associated with a fatal prognosis (p = 0.010, 0.010, and 0.010, respectively). Analysis of data from our cohort in conjunction with those from 46 previously reported patients with B. cereus sepsis identified similar risk factors, that is, acute leukemia, extremely low neutrophil count, and CNS symptoms (p = 0.044, 0.004, and 0.002, respectively). These results indicate that appropriate prophylaxis and early therapeutic intervention against possible B. cereus sepsis are crucially important in the treatment of hematologic malignancies.
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Inoue
authors.forename: Yuya
authors.initials: Y
authors.lastname: Nagai
authors.forename: Minako
authors.initials: M
authors.lastname: Mori
authors.forename: Seiji
authors.initials: S
authors.lastname: Nagano
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takiuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arima
authors.forename: Takaharu
authors.initials: T
authors.lastname: Kimura
authors.forename: Sonoko
authors.initials: S
authors.lastname: Shimoji
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Togami
authors.forename: Sumie
authors.initials: S
authors.lastname: Tabata
authors.forename: Soshi
authors.initials: S
authors.lastname: Yanagita
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsushita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nagai
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takegawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D016863:Bacillaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D001409:Bacillus cereus / Q000302:isolation & purification*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate