Breakthrough viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients receiving levofloxacin prophylaxis in a Japanese hospital

BMC Infectious Diseases

Research Article

Shinsuke Takagi¹  Kazuya Ishiwata¹  Hisashi Yamamoto¹  Naoyuki Uchida¹  Mitsuhiro Yuasa¹  Kosei Kageyama¹  Atsushi Wake¹  Go Yamamoto¹  Koji Izutsu¹  Yuki Asano-Mori¹  Daisuke Kaji¹  Aya Nishida¹  Shuichi Taniguchi²  Atsushi Yoshida³  Akira Hishinuma³  Yuki Okamoto³  Muneyoshi Kimura⁴  Masahiro Abe⁴  Hideki Araoka⁵  Akiko Yoneyama⁵ 

[1] Department of Hematology, Toranomon Hospital, Tokyo, Japan;Department of Hematology, Toranomon Hospital, Tokyo, Japan;Okinaka Memorial Institute for Medical Research, Tokyo, Japan;Department of Infection Control and Clinical Laboratory Medicine, Dokkyo Medical University, Tochigi, Japan;Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470, Tokyo, Japan;Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470, Tokyo, Japan;Okinaka Memorial Institute for Medical Research, Tokyo, Japan;

关键词: Allogeneic hematopoietic stem cell transplantation;    Febrile neutropenia;    Levofloxacin prophylaxis;    Levofloxacin breakthrough;    Ceftazidime;    Viridans streptococcus;   

DOI  :  10.1186/s12879-016-1692-y

 received in 2015-10-31, accepted in 2016-07-05,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundBreakthrough viridans streptococcal bacteremia (VSB) in patients with hematological malignancy receiving levofloxacin prophylaxis is a major blood stream infection (BSI) occurring during febrile neutropenia. However, clinical data focused on VSB in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are lacking.MethodsThe medical records of allo-HSCT recipients who received oral levofloxacin prophylaxis between January 2011 and August 2013 at Toranomon Hospital were reviewed to evaluate breakthrough VSB. Stored viridans streptococcal (VGS) species were identified by using sodA gene sequencing, and were assessed for drug susceptibility.ResultsAmong the 184 allo-HSCT recipients on levofloxacin prophylaxis, 28 (15.2 %) experienced breakthrough VSB. All of the 28 recipients with VSB were treated with a cefepime-based or piperacillin/tazobactam-based regimen. The susceptibility rates of the VGS strains for levofloxacin, cefepime, piperacillin/tazobactam, meropenem, and vancomycin were 0 %, 95 %, 100 %, 100 %, and 100 %, respectively. Both the MIC50 (minimum inhibitory concentration) and the MIC90 of ceftazidim (0.5 μg/mL and 2 μg/mL, respectively) were higher than the MIC90 of all the other anti-pseudomonal beta-lactams (APBLs). Only 1 VGS strain had a penicillin MIC ≥ 2 μg/mL by the Etest (3.6 %). There were no cases with acute respiratory distress syndrome (ARDS) that was associated with VSB, although the rate of viridans group streptococcal shock syndrome was high (26 %). The crude 30-day mortality rate in the VSB group (10.7 %) did not differ significantly from that in the BSI without VSB group (9.3 %) or non-BSI group (7.0 %) (P = 0.77). Also, VSB was not a risk factor for all-cause mortality up to 60 days following allo-HSCT (P = 0.43).ConclusionsAPBL with increased anti-VGS activity (APBL-VA) monotherapy would typically be optimal for treating the VGS strains in this setting. Indication of adding an empiric anti-gram-positive agent to APBL-VA for treating VSB should depend on local factors, such as the susceptibility results. In addition, breakthrough VSB is probably not a major cause of death in allo-HSCT settings, where beta-lactam non-susceptible VGS and the ARDS are rare.

【 授权许可】

CC BY   
© The Author(s). 2016