Lactobacillus Bacteremia in Febrile Neutropenic Patients

Abstract

may cause serious infection in immunosuppressed patients. CliniEmpirical antibiotic therapy for patients with febrile neutropenia cal syndromes associated with L. casei infection include endocardihas resulted in a decrease in the number of cases of bacteremia tis [1, 2], sepsis [3–6], pneumonia [7], meningitis [4], mediastinitis caused by enteric gram-negative bacilli. However, gram-positive [8], liver abscess [9], endometritis [6], amnionitis [5], and urinary organisms have emerged as a major cause of bacteremia in this tract infection [4]. Risk factors for bacteremia include neutropenia, population. We report the occurrence of a microaerophilic, gramprior surgery, malignancy, diabetes, and prior therapy with antimipositive rod, Lactobacillus casei, that caused bacteremia among a crobials inactive against Lactobacillus [5]. Empirical antibiotics significant number of febrile neutropenic patients who were receivsuch as cephalosporins, aminoglycosides, and vancomycin are freing antimicrobials active against this organism. quently used to treat febrile neutropenia but do not eradicate LactoWe reviewed the charts of 22 patients admitted to the H. Lee bacillus [5]. Patel et al. [4] reported that the use of vancomycin Moffitt Cancer Center and Research Institute in Tampa, Florida, in liver transplant recipients promoted colonization of the gastroinbetween January 1988 and June 1996. There were nine males and testinal tract and may constitute a contributing factor in the devel13 females; the mean age was 45.2 years (range, 17–69 years). opment of lactobacillemia. Lactobacillus species are usually susL. casei was isolated from the blood of all patients and from the ceptible to penicillins [1], ampicillin [2], clindamycin [4, 5], and urine of one; the organisms were cultured on both blood agar erythromycin [5], antibiotics that are not commonly used for emincubated at 357C in room air and chocolate agar incubated at 357C pirical therapy for febrile neutropenia. Bayer et al. [3] reported in a 5% CO2 environment. Species identification was performed by that a synergistic effect existed in vitro when penicillin or ampiciluse of the Vitek ANI identification system (bioMérieux Vitek, lin and gentamicin/streptomycin were used in the treatment of Hazelwood, MO). lactobacillemia. Vancomycin, used either alone or in combination Multiple species, notably Escherichia coli, Staphylococcus epiwith gentamicin or streptomycin, did not have antimicrobial activdermidis, or Candida species, were also recovered from the blood ity against Lactobacillus plantarum or L. casei. In another study of 14 study subjects. Lactobacillus bacteremia occurred in 22 paL. casei was found to be resistant to cefoxitin and vancomycin, tients with 10 types of tumors. with synergy between vancomycin and penicillin [2]. Neither A test for independent proportions indicated that bacteremia was L. casei nor Lactobacillus acidophilus was effectively controlled significantly more frequent (9 [6.01%] of 162) among patients by the use of gentamicin alone [2]. with acute myelogenous leukemia (AML) than among all others Lactobacillus becomes a potential pathogen in patients with in the hospital registry (13 [0.1%] of 9,047; t Å 4.1, P Å .0001). cancer when empirical antibiotics used to treat episodes of febrile The underlying malignancy most frequently complicated by bacterneutropenia lack activity against this organism. Capnocytophaga emia was AML (9 [5.4%] of 168), followed by all other leukemias infection, also seen in febrile neutropenic patients with mucositis, (11 [4.4%] of 250) and, rarely, breast cancer (5 [0.33%] of 1,535). similarly requires therapy with penicillin or clindamycin [10]. The The distribution of probable risk factors for lactobacillemia was widespread use of third-generation cephalosporins, aminoglycoas follows: neutropenia, 91% of patients (20 of 22); both mucositis sides, and vancomycin as empirical therapy for febrile neutropenia and neutropenia, 36.4% (8 of 22); and vancomycin therapy, 95.5% facilitates the development of lactobacillus infections. Once dis(21 of 22). Antibiotics frequently used before lactobacillus bactercovered and treated promptly, however, lactobacillus bacteremia emia occurred included vancomycin (95.5% of patients), ceftazareadily responds to treatment with penicillin, clindamycin, or dime (63.8%), tobramycin (63.8%), metronidazole (59.1%), azerythromycin in combination with gentamicin. treonam (45.5%), acyclovir (45.5%), and fluconazole (40.9%). Use

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@inproceedings{Cooper2010LactobacillusBI, title={Lactobacillus Bacteremia in Febrile Neutropenic Patients}, author={Christopher D Cooper and Albert L Vincent and John N Greene and Ramon L. Sandin and Ledya Cobian and South Florida and Joshua Axelrod and Deusch Gt and Bottone E and Cohen Sm and Hirschman Sz Endocarditis and Hobart Lee and Moffitt Cancer and Guze Lb Bayer and Lactobacillemia}, year={2010} }