Cytosine arabinoside as a major risk factor for Streptococcus viridans septicemia following bone marrow transplantation : a 5-year prospective study

• Published in: Bone marrow transplantation (Basingstoke) Vol. 16; no. 4; pp. 565 - 570
• Main Authors: ENGELHARD, D, ELISHOOV, H, RAHAV, G, SHAPIRO, M, SACKS, T, GIMON, Z, ABU-DALU, K, BRAUTBAR, C, SLAVIN, S, OR, R, NAPARSTEK, E, NAGLER, A, STRAUSS, N, CIVIDALLI, G, AKER, M, RAMU, N, SIMHON, A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.10.1995
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteremia - etiology; Biological and medical sciences; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Cross Infection - etiology; Cytarabine - adverse effects; Drug Resistance, Microbial; Female; Humans; Infant; Male; Medical sciences; Prospective Studies; Risk Factors; Streptococcal Infections - etiology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Antineoplastic agent; Human; Nosocomial infection; Transfusion; Septicemia; Homograft; Prospective; Streptococcaceae; Streptococcus; Risk factor; Bone marrow; Bacteria; Micrococcales; Complication; Graft; Pyrimidine nucleoside
• ISSN: 0268-3369

The incidence and clinical course of nosocomial septicemia with Streptococcus viridans was evaluated prospectively in 242 consecutive bone marrow transplant (BMT) recipients throughout their 15-213 days' (median 47) hospitalization, including 4-58 days (median 18) of neutropenia. Initial empiric therapy for febrile neutropenia consisted of mezlocillin, gentamicin and cefazolin; glycopeptide was excluded. S. viridans septicemia occurred in 23/209 (11%) subjects with underlying malignant disease, and only during neutropenia with concomitant mucositis: in 20 subjects (four with ampicillin-resistant strains), S. viridans septicemia occurred at onset of febrile neutropenia, 1-5 days (median 4.5) post-BMT. All survived with an uncomplicated clinical course. Thus, glycopeptide seems unnecessary in the initial empiric antibiotic regimen. The other three subjects demonstrated S. viridans septicemia (two with ampicillin-resistant strains) on day 11 post-BMT; two died. The major risk identified was cytosine arabinoside administration in the conditioning regimen (P < 0.01).