Cytosine arabinoside as a major risk factor for Streptococcus viridans septicemia following bone marrow transplantation: A 5-year prospective study

D. Engelhard*, H. Elishoov, R. Or, E. Naparstek, A. Nagler, N. Strauss, G. Cividalli, M. Aker, N. Ramu, A. Simhon, G. Rahav, M. Shapiro, T. Sacks, Z. Gimon, K. Abu-Dalu, C. Brautbar, S. Slavin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The incidence and clinical course of nosocomial septicemia with Streptococcus viridans was evaluated prospectively in 242 consecutive bone marrow transplant (BMT) recipients throughout their 15-213 days' (median 47) hospitalization, including 4-58 days (median 18) of neutropenia. Initial empiric therapy for febrile neutropenia consisted of mezlocillin, gentamicin and cefazolin; glycopeptide was excluded, S. viridans septicemia occurred in 23/209 (11%) subjects with underlying malignant disease, and only during neutropenia with concomitant mucositis: in 20 subjects (four with ampicillin-resistant strains), S. viridans septicemia occurred at onset of febrile neutropenia, 1-5 days (median 4.5) post-BMT. All survived with an uncomplicated clinical course. Thus, glycopeptide seems unnecessary in the initial empiric antibiotic regimen. The other three subjects demonstrated S. viridans septicemia (two with ampicillin-resistant strains) on day 11 post-BMT; two died. The major risk identified was cytosine arabinoside administration in the conditioning regimen (P < 0.01).

Original languageEnglish
Pages (from-to)565-570
Number of pages6
JournalBone Marrow Transplantation
Volume16
Issue number4
StatePublished - 1995
Externally publishedYes

Keywords

  • Ara-C
  • Bone marrow transplantation
  • Neutropenia
  • Septicemia
  • Streptococcus viridans

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