title: Clinical characteristics and antimicrobial susceptibilities of viridans streptococcal bacteremia during febrile neutropenia in patients with hematologic malignancies: a comparison between adults and children.
abstract: BACKGROUND
  This study was performed to compare the clinical characteristics and antibiotic susceptibilities of viridans streptococcal bacteremia (VSB) between febrile neutropenic adults and children with hematologic malignancies.
  
  
  METHODS
  The consecutive medical records of neutropenic patients with hematologic malignancies who were admitted to the Catholic Blood and Marrow Transplantation Center between April 2009 and July 2012, and who were subsequently diagnosed with VSB were reviewed retrospectively. A comparison was made between the clinical and laboratory characteristics of adults and pediatric patients and also between patients with cefepime susceptible or not susceptible VSB.
  
  
  RESULTS
  A total of 202 episodes (141 in adults, 61 in children) of VSB were identified. Among them, 26 (12.9%) cases had severe complications including four (2.0%) cases of death attributable to VSB. For antibacterial prophylaxis, most adults received ciprofloxacin (97.1%), but children more frequently received trimethoprim/sulfamethoxazole (86.9%). Oral mucositis (p = 0.005) and abdominal pain (p = 0.001) were found more frequently in adults, and cough was found more frequently in children (p = 0.004). The occurrence rates of severe complications and death attributable to VSB were not significantly different between adults and children. Susceptibility rate to cefepime was significantly higher in adults than children (85.7% vs. 66.1%, p = 0.002). However, in multivariate analysis, cefepime susceptibility had no impact on clinical outcome.
  
  
  CONCLUSIONS
  There was no significant difference in clinical outcome between adults and children with VSB despite a difference in cefepime susceptibility. Hence, different antibiotic treatment strategies may not be necessary.
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Seung Beom
authors.initials: SB
authors.lastname: Han
authors.forename: E Young
authors.initials: EY
authors.lastname: Bae
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: Nack-Gyun
authors.initials: NG
authors.lastname: Chung
authors.forename: Dae-Chul
authors.initials: DC
authors.lastname: Jeong
authors.forename: Bin
authors.initials: B
authors.lastname: Cho
authors.forename: Jin Han
authors.initials: JH
authors.lastname: Kang
authors.forename: Hack-Ki
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000188:drug therapy / Q000382:microbiology*; D000077723:Cefepime; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D064147:Febrile Neutropenia / Q000097:blood / Q000382:microbiology*; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000382:microbiology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D013290:Streptococcal Infections / Q000097:blood / Q000188:drug therapy / Q000382:microbiology*; D034363:Viridans Streptococci / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime