Viridans streptococcus bacteremia in children on chemotherapy for cancer: an underestimated problem

Area of Science:

• Pediatric Hematology/Oncology
• Infectious Diseases
• Microbiology

Background:

• Viridans streptococci are a significant cause of bacteremia in immunocompromised children.
• These infections lead to considerable morbidity in patients undergoing treatment for malignant conditions.

Purpose of the Study:

• To evaluate the clinical significance and treatment outcomes of viridans streptococcus bacteremia in pediatric oncology patients.
• To assess the implications of these infections on antibiotic prophylaxis and treatment strategies.

Main Methods:

• Retrospective analysis of medical records from 38 pediatric patients with malignant conditions.
• Review of 40 episodes of bacteremia caused by viridans streptococci between October 1995 and January 1999.
• Analysis of patient characteristics, including neutropenia, co-trimoxazole prophylaxis, and co-morbidities.

Main Results:

• Viridans streptococci were the third most common blood isolate, with Streptococcus mitis being the predominant species (55%).
• A high rate of treatment failure (60%) was observed, even when the organism was in vitro sensitive to antibiotics.
• Significant morbidity included abnormal chest X-rays (30%), hypotension (15%), and intensive care unit admissions (2 patients).

Conclusions:

• Viridans streptococcus bacteremia poses a substantial threat, causing significant morbidity in pediatric hematology and oncology patients.
• The high rate of clinical failure underscores the need for further research into optimal treatment regimens.
• This study emphasizes the importance of considering viridans streptococci in the management of febrile neutropenia in this population.