Increased incidence of bacteraemia due to viridans streptococci in an unselected population of patients with acute myeloid leukaemia

The aetiology, clinical characteristics and outcome of bacteraemia in patie nts with acute myeloid leukaemia were studied. AU positive blood cultures c ollected at a haematological ward during 2 7-y periods were evaluated. Alto gether, 274 episodes of bacteraemia in 152 patients mere recorded, 80 episo des during 1980-86 and 194 during 1990-96. During the 2 periods, trimethopr im-sulfamethoxazol in combination with amikacin was the first-line empirica l therapy in patients with neutropaenia and fever. In 1990, antimicrobial p rophylaxis with ciprofloxacin and fluconazole was introduced. The incidence of bacteraemia due to viridans streptococci or coagulase-negative staphylo cocci increased from the first period to the second, whereas the incidence of Enterobacteriaceae decreased. In granulocytopaenic patients during 1990- 96, viridans streptococci accounted for 21% of the isolates and in patients treated prophylactically with fluoroquinolone, viridans streptococci accou nted for 31%. All viridans streptococci were sensitive to penicillin. At th e time of the positive blood cultures, the patients of the second period, w ere granulocytopaenic in 83% of the episodes. The mortality related to sept icaemia during the later period was 13% and only 1 of 33 (3%) of the patien ts with viridans streptococci died. Eight patients (9%) died in relation to septicaemia following curative antileukaemic therapy.