Epidemiologic Evaluation of Rothia Bacteremias

Abstract

Background Clinicians may have previously considered Rothia spp as a contaminant, nonpathogenic flora, or rare etiology of infection. These organisms have been acknowledged as opportunistic pathogens particularly in immunocompromised patients, yet a dearth of information exists regarding this species. Our study investigated the characteristics and clinical outcomes associated with Rothia bacteremias in cancer patients. Methods We performed a single-center retrospective cohort study of patients with cancer with a positive blood culture for Rothia spp, from December 1, 2012 to May 17, 2017 at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla. Results Thirty-six patients who predominantly had hematologic malignancies and profound and prolonged neutropenia were identified. All patients rapidly cleared the bacteremia as was demonstrated by subsequent negative blood cultures, which were rechecked 24 to 48 hours after initiation of intravenous antimicrobial therapy. Characteristics previously identified as predisposing factors in Rothia-associated infections were present in our patients such as fluoroquinolone prophylaxis (78%), receipt of chemotherapy (100%), mechanical ventilation (8%), and central venous catheters (100%). Complications arose where patients developed sepsis or systemic inflammatory response syndrome (n = 21), pneumonia (n = 3), cellulitis (n = 2), and meningitis (n = 1). Over 75% of with sensitivities were susceptible to penicillin. The average duration of therapy was 11 ± 6 days. Conclusions Rothia bacteremia is a rare infection and associated with rapid clearance upon initiation of appropriate antimicrobial therapy. In vitro susceptibility is now available and should be performed on all isolates to identify cases where antibiotic deescalation and resistance may occur.