ALPHA.-Streptococcal Sepsis in Childhood Hematologic Disease

• Published in: The Japanese Journal of Pediatric Hematology Vol. 11; no. 1; pp. 20 - 25
• Main Authors: OTA Setsuo, 鈴木 宏, SAKAO Eiko, 諏訪部 信一, NOGUCHI Yasushi, IGARASHI Shunji, MIURA Nobuyuki, KAKUDA Harumi, 石川 信泰, KOMORI Isao, SUNANH Shosuke, 菅野 治重, OKIMOTO Yuri, SATO Takeyuki, NIIMI Hiroo
• Format: Journal Article
• Language: Japanese
• Published: THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 1997; 特定非営利活動法人 日本小児血液・がん学会
• Subjects: hematologic disease; sepsis; α-Streptococcus
• ISSN: 0913-8706; 1884-4723
• DOI: 10.11412/jjph1987.11.20

In all neutropenic patients with hematologic disease, selective decontamination of the digestive tract was instituted by oral administration of a nonabsorbable antimicrobial drug, polymyxin B (PLB), to decrease the gram-negative rods. During a 12 year period, from 1983 to 1994, the Department of Pediatrics, Chiba University School of Medicine diagnosed 32 episodes (23%) of a-streptococcal (α-Str) sepsis out of 142 positive blood cultures in children with hematologic disease, indicating that α-Str was one of the most frequent pathogens of sepsis in that period. All 32 episodes occurred at neutrophil counts of less than 100/μ1. Streptococcus mitis was the predominant type isolated from the blood cultures. Three patients died of intracranial hemorrhaging and one of septic shock. The other 28 cases, including six patients who developed interstitial pneumonia, were cured. The careful selection of antimicrobial drugs is important since some of the isolated strains showed a high minimal inhibitory concentration (MIC) against penicillins and first-generation cephems. Empiric antimicrobial therapy for febrile and neutropenic patients with hematological diseases should include antibiotics effective against α-Str. 千葉大学小児科では血液疾患に合併した好中球減少患児に対し1983年から, 消化管内グラム陰性桿菌減少を目的として非吸収性経口抗菌剤polymyxin B (PLB) の予防投与を行っている.その後1994年までの12年間に, 小児血液疾患に伴い142件の敗血症を経験したが, うち32件 (23%) がα溶血性連鎖球菌 (α-Str) 性敗血症であり, 最も頻度の高い原因菌の一つとなっている.全て好中球数100/μ1以下の時点で発症していた.分離菌はStreptococcus mitisが最も高頻度であった.死亡例は頭蓋内出血3例と敗血症性ショック1例であった.6件の間質性肺炎合併例を含め, 他の28件は全て治癒した.分離菌の薬剤感受性では, ペニシリン系や第一世代セフェム系に対し高い最小発育阻止濃度 (MIC) を示している菌株も多く, 注意を要すると考えられた.血液疾患患児の発熱の際には, α-Str敗血症も念頭にいれた抗生物質の選択が重要と考えられる.