Nutritionally Variant Streptococci Bacteremia in Cancer Patients: A Relatively Benign Occurrence
Nutritionally Variant Streptococci (Abiotrophia and Granulicatella) are found normally in the oropharynx, genitourinary tract, and intestinal tract. NVS are typically associated with endocarditis in immunocompetent patients and bacteremia in immunosuppressed patients. Chemotherapy-induced mucositis and neutropenia have previously been identified as risk factors in cancer patients. In this study we investigated the clinical characteristics of NVS bacteremia in cancer patients and identified risk factors and mortality rates associated with these infections.
We retrospectively reviewed all cases of NVS bacteremia occurring from June 1999 to April 2014 at H. Lee Moffitt Cancer Center and Research Institute. We collected data regarding baseline demographics and clinical characteristics such as age, sex, underlying malignancy, neutropenic status, duration of neutropenia, treatment, and outcome.
Thirteen patients were identified with positive NVS blood stream infection. Ten patients (77%) had hematologic malignancies. Seven patients (54%) were neutropenic with an average duration of 14 days. The median age was 60 years. There was no gender predilection. Seven patients had mucositis at the time of diagnosis. One patient had gingivitis with dental abscess. None of the patients developed infective endocarditis. Most patients were on empiric antimicrobial therapy with ciprofloxacin, levofloxacin or piperacillin/tazobactam at the time of breakthrough bacteremia. Almost all patients received vancomycin as definitive treatment. All the patients had transient bacteremia with an average duration of positive blood cultures of 1 day. The 30 day mortality rate was 16.67%. Mortality was not attributable to NVS bacteremia.
NVS should be considered as a possible agent of gram positive bacteremia in cancer patients with neutropenia and a breach in oral or gastrointestinal mucosa, especially chemotherapy-induced mucositis or gingivitis. We recommend against routine removal of the central venous catheters given the benign course of NVS bacteremia, rapid clearance from blood, and likely oral or GI tract source of the pathogen. NVS bacteremia did not contribute to the mortality of patients in our study.
J. Krishnan, None
J. Greene, None