Incidence and outcome of S. viridans bacteremia (SVB) in adult allogeneic HSCT patients Meeting Abstract

  


Authors: Sebti, A.; Jakubowski, A.; Small, T.; Jaffe, D.; Sepkowitz, K.; Pamer, E.; Papanicolaou, G.
Abstract Title: Incidence and outcome of S. viridans bacteremia (SVB) in adult allogeneic HSCT patients
Meeting Title: 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
Abstract: S. viridans is the most common organism in blood cultures (BC) 0-14d after HSCT at MSKCC. We therefore reviewed SVB cases to identify characteristics associated with acquisition and outcome. Methods: Retrospective review, 1998-2001. Cases: Pts >18y with SVB from -7 to +14 d after HSCT. Antibiotics (abx): gtoreq2 doses received from -7 to +7 d or SVB. Initial empiric neutropenic fever abx: Timentin/Amikacin. No routine quinolone prophylaxis. Attributable mortality: Death with shock and acute respiratory distress syndrome and no other cause identified. Results: 21/232 (9%) pts had SVB a median 4 (1-13) d after HSCT. 43% SV isolates were sensitive to penicillin (PCN). 20/21 pts had ANC <100 at the time of SVB. All pts had fever (mean Tmax 38.6degreeC). Pre SVB, only one pt on vancomycin, 10 on Timentin. Compared to HSCT population a greater proportion of SVB were female 81 vs 49% (p=.01), had underlying CML 47.6 vs 21% (p 0.08), peripheral blood stem cells (PBSCT) 62% vs 16% (p<.001), and fludarabine for conditioning regimen 38% vs 8% (p<.001). SV attributable mortality was 19% (4/21 pts), mean time to death: 22.5d. Fatal cases occurred significantly soon than non-fatal (2.5 vs 5.4 d post-HSCT. There was no difference in conditioning regimens or resistance to PCN. In a case-control analysis matched for age, sex and underlying disease, cases were more likely to have received PBSCT and fludarabine. More controls than cases had received vancomycin (p 0.001) peri HSCT. More cases than controls died 33% vs 14% (p=0.07) during admission for HSCT. Conclusions: 1) The incidence of SVB was 9%, with attributable mortality 19% in adult HSCT pts. 2) Female sex (p=.01), PBSCT (p<.001) and fludarabine (p<.001) were associated with SVB. 3) Early SVB was associated with mortality. 4) There was no association between resistance to PCN and mortality 5) Vancomycin should be strongly considered in the initial antibiotic regimen of fever in the early (0-7 d) HSCT period and continued if blood cultures yield a susceptible organism.
Keywords: infection incidence; infection outcome; patient mortality rates
Journal Title: Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy
Volume: 42
Meeting Dates: 2002 Sep 27-30
Meeting Location: San Diego, CA
ISSN: 0733-6373
Publisher: American Society for Microbiology  
Date Published: 2002-01-01
Start Page: 324
Language: English
ACCESSION: BCI:BCI200300348049
PROVIDER: biosis
Notes: Meeting Abstract: K-1228 -- 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy -- San Diego, CA, USA -- September 27-30, 2002 -- American Society for Microbiology -- Source: Biosis