Pneumococcal Bacteremia in Patients With Cancer

Abstract

Background One of the major causes of morbidity and mortality in patients with cancer is infection. Gram-positive bacteremias now represent 40% to 50% of all bacteremic episodes in neutropenic patients with cancer. However, pneumococcal bacteremia is uncommon in patients with cancer including those who are neutropenic. Resistance to commonly used antibiotics is expected in our population because of heavy exposure to prophylactic and empiric use of fluoroquinolones and β-lactams. Materials and Methods We reviewed the records of patients with documented Streptococcus pneumoniae bacteremia at the Moffitt Cancer Center between June 2003 and January 2013. The study population was identified by positive blood cultures obtained from the microbiology laboratory during the same period of time. Results During the study period, 27 episodes of Streptococcus pneumoniae bacteremia occurred and were analyzed. Of the 27 patients, 13 (48%) were males with a mean age of 55 years (range, 22–78 years). Most of the patients (78%) received empirical antibiotic treatment as soon as bacteremia was clinically suspected on the basis of fever. Ten (37%) cases were resistant to ceftriaxone, 11 (41%) were resistant to penicillin, and 13 (48%) were resistant to levofloxacin. Seven (26%) patients were neutropenic (absolute neutrophil count, <1500/uL) at the onset of the bacteremia. Thirteen (50%) had hematologic malignancies and 13 (50%) had a solid tumor. Four (15%) patients had chronic obstructive pulmonary disease, 3 (11%) had asthma, and 1 (4%) had pulmonary fibrosis. One patient did not receive any empirical treatment, deteriorated, and died within 24 hours after onset of the initial symptoms. Overall, 3 (11%) patients died during their hospital stay. Conclusions Pneumococcal bacteremia is found in patients with humoral immune defects such as chronic lymphocytic leukemia, lymphoma, multiple myeloma, and those with underlying lung disease. Although pneumococcal bacteremia remains rare in patients with cancer including those with neutropenia, resistance to commonly used antibiotics is higher than expected. Our study illustrates the difficulty of choosing empiric antibiotics for patients with suspected pneumococcal bacteremia with such a high level of resistance.