VIRIDANS STREPTOCOCCAL BACTEREMIA DUE TO PENICILLIN-RESISTANT AND PENICILLIN-SENSITIVE STREPTOCOCCI - ANALYSIS OF RISK-FACTORS AND OUTCOME IN 60 PATIENTS FROM A SINGLE CANCER-CENTER BEFORE AND AFTER PENICILLINIS USED FOR PROPHYLAXIS

60 patients with 60 viridans streptococcal bacteraemic episodes (42 du e to penicillin-sensitive and 18 due to penicillin-resistant viridans streptococci) were analysed in a population of 12,185 admissions and 1 ,380 bacteraemic episodes during a 7-year period in a National Cancer Institute. The incidence of viridans streptococci among bacteraemias d ecreased from 11.5% in 1989 to 2.5% in 1995 after penicillin was intro duced for prophylaxis of febrile neutropenia in acute leukaemia in 199 3. However, the proportion of penicillin-resistant viridans streptococ cal bacteraemias increased from 0 in 1989 and 1990 before any prophyla xis was given, to 12.9-16.7% after quinolones were used for prophylaxi s in 1991 and 1992, and to 44.4-81.8% in 1993-1995 after penicillin wa s added to the quinolones. Mortality rate was higher in the subgroup o f penicillin-resistant viridans streptococcal bacteraemias (p < 0.05). Statistically significant risk factors in patients with penicillin-re sistant (compared with penicillin-sensitive) viridans streptococcal ba cteraemia were: acute leukaemia (p < 0.03), high doses of cytarabine ( p < 0.05), mucocutaneous lesions (p < 0.001), breakthrough bacteraemia during prophylaxis with ofloxacine plus penicillin (p < 0.001). Multi ple logistic regression analysis shelved that only acute leukaemia (OR 2.05, CI 0.85-1.85, p < 0.0452) and penicillin-resistance (OR 0.71, C I 0.103-4.887, p < 0.0209) were significant independent predictors of inferior outcome. Breakthrough bacteraemia during empiric therapy with vancomycine occurred in 5 of 116 patients treated with vancomycine, a nd during therapy with ampicillin plus gentamicin in 6 patients of 18 treated.