Volume 20, Number 5—May 2014
Research
Streptococcus mitis Strains Causing Severe Clinical Disease in Cancer Patients
Table 1
Characteristic | No. (%) |
---|---|
Sex | |
M | 64 (54) |
F |
54 (46) |
Mean age, y (SD, range) |
50 (18, 10–79) |
Malignancy | 70 (59) |
Leukemia/myelodysplastic syndrome | 20 (17) |
Hematopoietic stem cell transplantation | 10 (8) |
Lymphoma/myeloma | 18 (15) |
Solid tumor |
20 (17) |
Neutrophils <500/μL |
95 (81) |
Clinical syndrome | |
Primary bacteremia | 95 (80) |
Gastrointestinal focus | 8 (7) |
Skin/soft tissue focus | 4 (3) |
Infective endocarditis | 2 (2) |
Clinically minor bacteremia |
9 (7) |
Polymicrobial infection |
22 (19) |
Pitt bacteremia score†‡ | |
0 | 35 (37) |
1 | 36 (38) |
2 | 5 (5) |
3 | 7 (7) |
>4 |
13 (13) |
Antimicrobial drug susceptibility | |
Penicillin | 54 (46) |
Ceftriaxone | 107 (91) |
Moxifloxacin | 60 (51) |
Tetracycline | 69 (59) |
*All patients had viridans group streptococci bacteremia. Unless otherwise noted, data are no. (%) of patients.
†Severity of infection was measured by the Pitt bacteremia score as described (21). Scores of 0 or 1 indicate clinically mild infections; scores of >2 indicate moderate to severe infections.
‡Determined only for patients with monomicrobial infection.
References
- Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486:207–14 . DOIPubMedGoogle Scholar
- Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis. 2002;34:1524–9 . DOIPubMedGoogle Scholar
- Dix D, Cellot S, Price V, Gillmeister B, Ethier MC, Johnston DL, Association between corticosteroids and infection, sepsis, and infectious death in pediatric acute myeloid leukemia (AML): results from the Canadian Infections in AML Research Group. Clin Infect Dis. 2012;55:1608–14. DOIPubMedGoogle Scholar
- Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG Jr, Bayer AS, Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis–Prospective Cohort Study. Arch Intern Med. 2009;169:463–73 . DOIPubMedGoogle Scholar
- Seltz LB, Smith J, Durairaj VD, Enzenauer R, Todd J. Microbiology and antibiotic management of orbital cellulitis. Pediatrics. 2011;127:e566–72. DOIPubMedGoogle Scholar
- Seo HS, Xiong YQ, Mitchell J, Seepersaud R, Bayer AS, Sullam PM. Bacteriophage lysin mediates the binding of Streptococcus mitis to human platelets through interaction with fibrinogen. PLoS Pathog. 2010;6:e1001047. DOIPubMedGoogle Scholar
- Facklam R. What happened to the streptococci: overview of taxonomic and nomenclature changes. Clin Microbiol Rev. 2002;15:613–30 . DOIPubMedGoogle Scholar
- Teles C, Smith A, Ramage G, Lang S. Identification of clinically relevant viridans group streptococci by phenotypic and genotypic analysis. Eur J Clin Microbiol Infect Dis. 2011;30:243–50. DOIPubMedGoogle Scholar
- Hoshino T, Fujiwara T, Kilian M. Use of phylogenetic and phenotypic analyses to identify nonhemolytic streptococci isolated from bacteremic patients. J Clin Microbiol. 2005;43:6073–85. DOIPubMedGoogle Scholar
- Kawamura Y, Hou XG, Sultana F, Miura H, Ezaki T. Determination of 16S rRNA sequences of Streptococcus mitis and Streptococcus gordonii and phylogenetic relationships among members of the genus Streptococcus. Int J Syst Bacteriol. 1995;45:406–8 . DOIPubMedGoogle Scholar
- Bochud PY, Eggiman P, Calandra T, Van Melle G, Saghafi L, Francioli P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis. 1994;18:25–31 . DOIPubMedGoogle Scholar
- Gassas A, Grant R, Richardson S, Dupuis LL, Doyle J, Allen U, Predictors of viridans streptococcal shock syndrome in bacteremic children with cancer and stem-cell transplant recipients. J Clin Oncol. 2004;22:1222–7. DOIPubMedGoogle Scholar
- Wisplinghoff H, Reinert RR, Cornely O, Seifert H. Molecular relationships and antimicrobial susceptibilities of viridans group streptococci isolated from blood of neutropenic cancer patients. J Clin Microbiol. 1999;37:1876–80 .PubMedGoogle Scholar
- Elting LS, Bodey GP, Keefe BH. Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors. Clin Infect Dis. 1992;14:1201–7. DOIPubMedGoogle Scholar
- Kitten T, Munro CL, Zollar NQ, Lee SP, Patel RD. Oral streptococcal bacteremia in hospitalized patients: taxonomic identification and clinical characterization. J Clin Microbiol. 2012;50:1039–42. DOIPubMedGoogle Scholar
- Bilgrami S, Feingold JM, Dorsky D, Edwards RL, Clive J, Tutschka PJ. Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant. 1998;21:591–5. DOIPubMedGoogle Scholar
- Husain E, Whitehead S, Castell A, Thomas EE, Speert DP. Viridans streptococci bacteremia in children with malignancy: relevance of species identification and penicillin susceptibility. Pediatr Infect Dis J. 2005;24:563–6. DOIPubMedGoogle Scholar
- Ikryannikova LN, Lapin KN, Malakhova MV, Filimonova AV, Ilina EN, Dubovickaya VA, Misidentification of alpha-hemolytic streptococci by routine tests in clinical practice. Infect Genet Evol. 2011;11:1709–15 . DOIPubMedGoogle Scholar
- Bishop CJ, Aanensen DM, Jordan GE, Kilian M, Hanage WP, Spratt BG. Assigning strains to bacterial species via the Internet. BMC Biol. 2009;7:3 . DOIPubMedGoogle Scholar
- Swenson FJ, Rubin SJ. Clinical significance of viridans streptococci isolated from blood cultures. J Clin Microbiol. 1982;15:725–7 .PubMedGoogle Scholar
- Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum β-lactamase production in nosocomial Infections. Ann Intern Med. 2004;140:26–32 . DOIPubMedGoogle Scholar
- Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest. 2009;136(Suppl):e28 .PubMedGoogle Scholar
- Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005. JAMA. 2008;299:2056–65. DOIPubMedGoogle Scholar
- Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8. DOIPubMedGoogle Scholar
- Han XY, Kamana M, Rolston KV. Viridans streptococci isolated by culture from blood of cancer patients: clinical and microbiologic analysis of 50 cases. J Clin Microbiol. 2006;44:160–5. DOIPubMedGoogle Scholar
- Hillier LW, Marth GT, Quinlan AR, Dooling D, Fewell G, Barnett D, Whole-genome sequencing and variant discovery in C. elegans. Nat Methods. 2008;5:183–8. DOIPubMedGoogle Scholar
- Tritt A, Eisen JA, Facciotti MT, Darling AE. An integrated pipeline for de novo assembly of microbial genomes. PLoS ONE. 2012;7:e42304. DOIPubMedGoogle Scholar
- Aziz RK, Bartels D, Best AA, DeJongh M, Disz T, Edwards RA, The RAST server: rapid annotations using subsystems technology. BMC Genomics. 2008;9:75. DOIPubMedGoogle Scholar
- Sinner SW, Tunkel AR. Viridans group streptococci, groups C and G streptococci, and Gemella morbilliform. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 7th ed. Philadelphia: Elsevier; 2011. p. 2434–50.
- Denapaite D, Bruckner R, Nuhn M, Reichmann P, Henrich B, Maurer P, The genome of Streptococcus mitis B6—what is a commensal? PLoS ONE. 2010;5:e9426. DOIPubMedGoogle Scholar
- Kilian M, Poulsen K, Blomqvist T, Havarstein LS, Bek-Thomsen M, Tettelin H, Evolution of Streptococcus pneumoniae and its close commensal relatives. PLoS ONE. 2008;3:e2683. DOIPubMedGoogle Scholar
- Pérez-Dorado I, Galan-Bartual S, Hermoso JA. Pneumococcal surface proteins: when the whole is greater than the sum of its parts. Mol Oral Microbiol. 2012;27:221–45.
- Pizzo PA, Ladisch S, Witebsky FG. Alpha-hemolytic streptococci: clinical significance in the cancer patient. Med Pediatr Oncol. 1978;4:367–70. DOIPubMedGoogle Scholar
- Burden AD, Oppenheim BA, Crowther D, Howell A, Morgenstern GR, Scarffe JH, Viridans streptococcal bacteraemia in patients with haematological and solid malignancies. Eur J Cancer. 1991;27:409–11. DOIPubMedGoogle Scholar
- Villablanca JG, Steiner M, Kersey J, Ramsay NK, Ferrieri P, Haake R, The clinical spectrum of infections with viridans streptococci in bone marrow transplant patients. Bone Marrow Transplant. 1990;5:387–93 .PubMedGoogle Scholar
- Ramphal R. Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin Infect Dis. 2004;39(Suppl 1):S25–31 . DOIPubMedGoogle Scholar
- Roberts RB, Krieger AG, Schiller NL, Gross KC. Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci. Rev Infect Dis. 1979;1:955–66 . DOIPubMedGoogle Scholar
- Jung CJ, Yeh CY, Shun CT, Hsu RB, Cheng HW, Lin CS, Platelets enhance biofilm formation and resistance of endocarditis-inducing streptococci on the injured heart valve. J Infect Dis. 2012;205:1066–75. DOIPubMedGoogle Scholar
- Westling K, Julander I, Ljungman P, Vondracek M, Wretlind B, Jalal S. Identification of species of viridans group streptococci in clinical blood culture isolates by sequence analysis of the RNase P RNA gene, rnpB. J Infect. 2008;56:204–10. DOIPubMedGoogle Scholar
- Musher DM, Roig IL, Cazares G, Stager CE, Logan N, Safar H. Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study. J Infect. 2013;67:11–8 . DOIPubMedGoogle Scholar
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