title: A case series of Bacillus cereus septicemia in patients with hematological disease.
abstract: OBJECTIVE
  Bacillus cereus (B. cereus) septicemia is a cause of life-threatening infection in patients with hematologic diseases. However, preventing a fatal prognosis in patients with B. cereus infection has not yet been achieved due to insufficient clinical investigations. To discover more optimal treatment strategies, we analyzed B. cereus septicemia in patients with hematologic diseases.
  
  
  METHODS
  At our institution, we observed 13 cases of B. cereus septicemia in 12 patients with hematologic diseases between January 2001 and September 2010. The susceptibility of B. cereus strains to antibiotics was also analyzed.
  
  
  RESULTS
  Of 12 patients, four died of B. cereus septicemia. In this study, the delayed administration of appropriate antibiotics (starting >24 hours after presentation), the presence of liver dysfunction and evidence of central nervous system (CNS) involvement tended to result in a fatal prognosis. All of the bacterial strains were found to be susceptible to vancomycin and quinolones (such as ciprofloxacin and levofloxacin), whereas many strains were resistant to clindamycin (76.9%) and imipenem (30.8%). In seven of 10 patients, central venous (CV) catheter tips were removed and routinely cultured. Catheter tip cultures were positive for B. cereus in three of seven patients.
  
  
  CONCLUSIONS
  Although not specific to B. cereus bacteremia, patients who died of B. cereus tended to present with CNS symptoms and/or liver dysfunction. Our clinical data suggested that carbapenem and clindamycin are no longer appropriate choices for treating B. cereus. In addition, B. cereus septicemia was found to frequently originate from CV catheters. Constant attention must be paid to update assessments of antibiotic susceptibility and careful management must be applied to CV catheters in patients with hematologic diseases.
authors.affiliation: Department of Hematology and Rheumatology, Nihon University School of Medicine, Itabashi Hospital, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Uchino
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Iriyama
authors.forename: Ken
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hirabayashi
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Miura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kurita
authors.forename: Yujin
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Mai
authors.initials: M
authors.lastname: Yagi
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kodaira
authors.forename: Atsuko
authors.initials: A
authors.lastname: Hojo
authors.forename: Sumiko
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hatta
authors.forename: Jin
authors.initials: J
authors.lastname: Takeuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001409:Bacillus cereus / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D055499:Catheter-Related Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors