STREPTOCOCCUS-PYOGENES BACTEREMIA - THE IMPACT OF PREVIOUS RADIATION AND CLINDAMYCIN RESISTANCE

Thirty-six patients with bacteraemia due to Lancefield Group A Strepto coccus (LCAS) infection were hospitalized at National Taiwan Universit y Hospital, Taiwan, from January 1982 to September 1994. Infection in 29 of these patients was community-acquired. Thirty patients were adul ts. Solid tumour was present in 30%. Local complications caused by rad iation therapy were found to be the most common predisposing factor fo r developing LCAS bacteraemia in these cancer patients. Resistance rat es to tetracycline, erythromycin, clindamycin, and chloramphenicol wer e 33, 29, 19 and 16 per cent, respectively. Cross-resistance to erythr omycin and tetracyline was detected in all seven clindamycin-resistant strains. The mortality rate directly related to bacteraemia was 16.7% and 84% of these died within 2 days of onset of septicaemia. Five adu lt patients had streptococcal toxic shock syndrome, all of whom died. This study revealed unique predisposing host factors for LGAS bacterae mia and high resistance rates to non-beta lactam antimicrobial agents.