Risk factors of Viridans Streptococci bloodstream infection in children with Acute leukemia: Case control study.

Abstract

Background: Viridans Streptococci (VS) bacteremia in patients with fever and leukemia has significantly increased over the last years. Risk factors described in this population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. Literature on pediatric patients is scarce Methods & Materials: Case Control retrospective study. Patients with Acute Leukemia admitted between July 2016 and October 2017 in a high-complexity pediatric hospital were included. Patients with fever and VS bacteremia were defined as cases. Patients with fever were defined as controls. Two controls were included by each case. Predisposing factors, clinical and microbiological characteristics were compared. STATA 10 was used Results: n: 90 (30 cases and 60 controls). Fifty one (57%) were male. Mean age was 67 months (IQR 38-107) St mitis/oralis was the most frequent (27/30), followed by St. salivarius (2/30) and St. sanguinis (1/30). Out of 30 isolates of VS 10% exhibited penicillin resistance and 30% intermediate penicillin resistance. Twenty percent of the strains were resistant to ceftriaxone In bivariate analysis, AML (OR 6.8, 95% CI 2.5- 18.2 p < 0.001), severe neutropenia (OR 16.9, 95%CI 2.1-133.1, p 0.007), high doses cytosine arabinoside (OR 4.0 95% IC 1.6- 10.4 p 0.004), oral mucositis (OR 2.9 95%IC 1.0- 8.8 p 0.048) and intensive care unit requirements (OR 11.2 95%IC 2.2-57.2 p 0.005) were associated with VS bacteremia. No association with the use of central venous catheter, co-trimoxazole prophylaxis, previous antibiotics or viral coinfection was found After adjustment by multivariate analysis, variables that remained associated with increased risk of VS bacteremia were AML (OR 6.8 95%IC 1.9-24.2 p 0.003), severe neutropenia (OR 10.1 95%IC 1.2-85.8 p 0.034) and oral mucositis (OR 7.3 95%IC 1.6-33.1 p 0.010) Conclusion: The isolation of VS has become frequent in immunocompromised individuals. AML, severe neutropenia, and the presence of oropharyngeal mucositis were risk factors associated with VS in this study