Dental health and viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 27; no. 5; pp. 537 - 542
• Main Authors: GRABER, C. J, DE ALMEIDA, K. N. F, ATKINSON, J. C, JAVAHERI, D, FUKUDA, C. D, GILL, V. J, BARRETT, A. J, BENNETT, J. E
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.03.2001
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - administration & dosage; Bacteremia; Bacteremia - drug therapy; Bacteremia - etiology; Biological and medical sciences; Blood culture; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell culture; Dental health; Female; Fever; Hematologic Neoplasms - complications; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Male; Medical sciences; Microbial Sensitivity Tests; Neutropenia; Norfloxacin; Prophylaxis; Stem cell transplantation; Stem cells; Stomatognathic Diseases - complications; Streptococcal Infections - drug therapy; Streptococcal Infections - etiology; Streptococcus; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous - adverse effects; Stem cell; Leukemia; Hematopoietic cell; Homograft; Hemopathy; Myeloma; Immunoglobulinopathy; Lymphoproliferative syndrome; Bacteria; Micrococcales; Complication; Graft; Neutropenia; Human; Immunopathology; Leukopenia; Stomatology; Dental disease; Malignant hemopathy; Bacteremia; Infection; Streptococcaceae; Streptococcus; Treatment; Risk factor; Bacteriosis
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702818

Viridans streptococci were the most common cause of bacteremia in 61 consecutive myeloablative allogeneic hematopoietic stem cell transplant (HSCT) recipients, occurring in 19 of 31 bacteremic patients (61%) during the period of post-transplant neutropenia. Seven of the 19 had more than one viridans streptococcus in the same blood culture. Twenty isolates from 15 patients were Streptococcus mitis. Most viridans streptococci were resistant to norfloxacin, used routinely for prophylaxis. Comparison of the 19 patients with viridans streptococcal bacteremia with a contemporaneous group of 23 allogeneic HSCT recipients with fever and neutropenia but no identified focus of infection found that patients with viridans streptococcal bacteremia were more likely to have severe intraoral pathology while neutropenic (26% vs 0%) and slightly shorter interval between the last dental procedure and the onset of neutropenia (11 vs 14 days). Poor underlying dental health and the use of norfloxacin thus appear to predispose to viridans streptococcal bacteremia.