Methods: We performed a single-center retrospective cohort study to evaluate characteristics and clinical outcomes in cancer patients with Rothia bacteremia from December 1, 2012 to December 31, 2015 at the H. Lee Moffitt Cancer Center and Research Institute.
Results: Twenty-five patients with Rothia mucilaginosa bacteremia were identified. Most Rothia bacteremia occurred among patients with acute myeloid leukemia (68%). Prolonged or profound neutropenia was the most frequent risk factor. The number of positive blood cultures was significantly associated with the duration of neutropenia (p<0.05). Fluoroquinolone prophylaxis was significantly associated with the occurrence of bacteremia (p<0.05). Mechanical ventilation and presence of CVC were also associated with a higher risk of Rothia bacteremia. Sepsis or systemic inflammatory response syndrome occurred in 36% of our Rothia bacteremic patients, 8% had pneumonia, and 8% died of complications presumed to be associated with infection. All eight isolates with susceptibility testing results available were susceptible to vancomycin whereas only five (62.5%) were susceptible to penicillin. All patients rapidly cleared the bacteremia after initiation of intravenous antimicrobial therapy.
Conclusion: Rothia bacteremia albeit rare, is progressively encountered among patients with hematologic malignancies and neutropenia. A high index of suspicion is needed to include a potential Rothia bacteremia in the differential diagnosis of septic patients. Rothia are universally susceptible to vancomycin and sometimes to penicillin. In vitro susceptibility testing is available and should be done on pathogenic Rothia blood isolates to identify cases where antibiotic de-escalation and resistance may occur. Rothia bacteremia is treatable without CVC removal, but if untreated may cause complications including mortality.
S. Nanjappa, None
J. Greene, None