Pneumococcal Bacteremia in Cancer Patients: A Case Series
One of the major causes of morbidity and mortality in cancer patients is infection. Gram-positive bacteremias now represent 40 to 50% of all bacteremic episodes in neutropenic cancer patients. However, pneumococcal bacteremia is uncommon in cancer patients including those who are neutropenic. Resistance to commonly used antibiotics is expected in our population due to heavy exposure to prophylactic and empiric use of fluoroquinolones and beta lactams.
We reviewed the records of patients with documented Streptococcus pneumoniae bacteremia at the Moffitt Cancer Center between June 2003 and January 2013. The study population was identified by positive blood cultures obtained from the Microbiology Laboratory over the same period of time.
During the study period, 27 episodes of Streptococcus pneumoniae bacteremia occurred, and were analyzed. Of the 27 patients, 15 were males (56%) with a mean age of 55 years (range: 22-78 years). Most of the patients (78%) received empirical antibiotic treatment as soon as bacteremia was clinically suspected on the basis of fever. Ten (37%) cases were resistant to Ceftriaxone, 11 (41%) were resistant to Penicillin, and 13 (48%) were resistant to Levofloxacin. Seven (26%) patients were neutropenic (PMN < 1500/uL) at the onset of the bacteremia. Thirteen (59%) had a hematologic malignancies and 11 (41%) had a solid tumor. Four (15%) patients had COPD, 3 (11%) had asthma and 1 (4%) had pulmonary fibrosis. One patient did not receive any empirical treatment, deteriorated and died within 24 hours after onset of the initial symptoms. Overall, 3 (11%) patients died during their hospital stay.
Although pneumococcal bacteremia remains rare in cancer patients including those with neutropenia, resistance to commonly used antibiotics is higher than expected. Our study illustrates the difficulty of choosing empiric antibiotics for patients with suspected pneumococcal bacteremia with such a high level of resistance.
J. Greene, None
S. Quaiser, None
R. Monta, None