Three cases of viridans group streptococcal bacteremia in children with febrile neutropenia and literature review

The Role of Corticosteroids in Adult Respiratory Distress Syndrome caused by Viridans Group Streptococci Bacteremia in Neutropenic Patients

In the past decades, viridans group Streptococci (VGS) have emerged as an important cause of bacteremia in neutropenic patients with cancer. The clinical course of VGS bacteremia can be devastating including septic shock and adult respiratory distress syndrome (ARDS). It has been suggested that septicemia with VGS triggers the development of noncardiogenic pulmonary edema in patients with pre-existing damage of the lungs due to aggressive cytotoxic treatment. Thus, the preemptive administration of corticosteroid to patients diagnosed with VGS bacteremia with early onset of respiratory failure has been employed to prevent ARDS. While this management strategy has been suggested in the literature, little published data are available to validate this practice. In this study, we sought to review the benefit of early administration of corticosteroid to patients who developed symptom or early signs of respiratory failure while being neutropenic with VGS bacteremia.

The use of antimicrobial agents in children with fever during chemotherapy-induced neutropenia: the importance of risk stratification

Children with fever and chemotherapy-induced or cancer-associated neutropenia should be assessed with complete history and physical examinations, undergo appropriate diagnostic studies, and promptly receive broad-spectrum empirical antimicrobial therapy. Assessment of risk for severe infection is crucial in determining the appropriate antimicrobial, route, venue, and duration of empirical antimicrobial therapy and need for prophylactic antimicrobial agents.

In vitro inferiority of ceftazidime compared with other beta-lactams for viridans group Streptococcus bacteremia in pediatric oncology patients: implications for antibiotic choices

Viridans group Streptococcus (VGS) is a leading cause of bacteremia in pediatric oncology patients, primarily in children with acute myeloid leukemia or after hematopoietic stem cell transplantation. We retrospectively identified all positive blood cultures in oncology patients at the British Columbia Children's Hospital for a period of 54 months. VGS was the second most commonly isolated pathogen, present in 19% of all the positive blood cultures. Susceptibility analysis of 46 VGS isolates from that period was performed using the Etest method for penicillin, cefotaxime, ceftazidime, and piperacillin/tazobactam. The geometric mean minimal inhibitory concentration for ceftazidime was found to be 9 to 12-fold higher than for any other beta-lactam antibiotic. Penicillin resistance was of 13% with an additional 20% of samples with intermediate susceptibility. The study underscores the prevalence of VGS bacteremia in pediatric patients, especially with acute myeloid leukemia or postallogeneic hematopoietic stem cell transplantation, and the in vitro inferiority of ceftazidime compared with other beta-lactams in that context. We conclude that monotherapy with ceftazidime, or its use along with an aminoglycoside, is not an optimal therapy in pediatric oncology patients with febrile neutropenia.