title: Viridans Group Streptococcal Infections in Children After Chemotherapy or Stem Cell Transplantation: A 10-year Review From a Tertiary Pediatric Hospital.
abstract: Viridans Group Streptococci (VGS) are associated with high mortality rates in febrile neutropenia; yet there are no recent European pediatric studies to inform antimicrobial therapy. The aim of this study was to describe the characteristics, outcome, and resistance patterns of children with VGS bacteremia (VGSB) undergoing treatment of malignancy or hematopoietic stem cell transplant. Patients aged 0 to 18 years, admitted to a tertiary pediatric hemato-oncology center with VGSB, from 2003 to 2013, were included in the study. All data were collected retrospectively from medical records. A total of 54 bacteremic episodes occurred in 46 patients. The most common underlying diagnosis was relapsed acute lymphoblastic leukemia. Streptococcus mitis was the most frequent organism. A total of 30% of isolates were resistant to penicillin and 100% sensitive to vancomycin. There were 8 episodes (14.8%) of Viridans Group Streptococcal Shock Syndrome; 6 resulted in admission to intensive care and 3 of these patients died of multiorgan failure. The potentially fatal nature of VGSB is confirmed. The high risk in relapsed acute lymphoblastic leukemia is of note. Research is needed to develop risk-stratification scores that identify children at risk of Viridans Group Streptococcal Shock Syndrome to guide empirical antimicrobial therapy in febrile neutropenia.
authors.affiliation: From the Department of Oncology, Alder Hey Children's NHS Foundation Trust (MJN, BP); Institute of Infection and Global Health, University of Liverpool (SC, EDC, SP); Institute of Translational Medicine, University of Liverpool (SL, BP); Department of Microbiology, Alder Hey Children's NHS Foundation Trust (RPDC); and Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust (SP, EDC), Liverpool, UK.
authors.forename: Maryke J
authors.initials: MJ
authors.lastname: Nielsen
authors.forename: Sarah
authors.initials: S
authors.lastname: Claxton
authors.forename: Barry
authors.initials: B
authors.lastname: Pizer
authors.forename: Steven
authors.initials: S
authors.lastname: Lane
authors.forename: Richard P D
authors.initials: RPD
authors.lastname: Cooke
authors.forename: Stéphane
authors.initials: S
authors.lastname: Paulus
authors.forename: Enitan D
authors.initials: ED
authors.lastname: Carrol
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D062606:Tertiary Care Centers; D034363:Viridans Streptococci
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents