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

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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