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Prevention of viridans-group streptococcal septicemia in oncohematologic patients: A controlled comparative study on the effect of penicillin G and cotrimoxazole

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Summary

In a controlled randomized study among 48 patients undergoing 75 courses of aggressive antileukemic therapy, it was shown that cotrimoxazole was less effective than penicillin G in preventing septicemia due to viridans streptococci. Both antibiotics were given intravenously. During 35 episodes of chemotherapy in the group of patients on penicillin G only, one patient developed a streptococcal bacteremia; this contrasted with bacteremia and septicemia in seven patients during 40 episodes in the group on cotrimoxazole. In three of these seven patients, septicemia was associated with respiratory failure and it was the cause of death in one. Both aerobic gram-negative rods and streptococci which caused infection despite cotrimoxazole prophylaxis were resistant to cotrimoxazole. Side effects such as hypersensitivity and favorable or unfavorable interaction with the oral selective decontamination regimen were similar for the two drugs, with the exception of colonization withCandida spp, which occurred more often in patients on cotrimoxazole than in patients on penicillin.

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References

  1. Andersson BS, Luna MA, Yee C, Hui KK, Keating MJ, McCredie KB (1990) Fatal pulmonary failure complicating high-dose cytosine arabinoside therapy in acute leukemia. Cancer 65: 1079–1084

    PubMed  Google Scholar 

  2. Bodey GP, Rodriguez V, Chang HY, Narboni G (1978) Fever and infection in leukemic patients. A study of 464 consecutive patients. Cancer 41: 1610–1622

    PubMed  Google Scholar 

  3. Bostrom B, Weisdorf D (1984) Mucositis and α-streptococcal sepsis in bone marrow transplant recipients. Lancet 1:1120–1121

    Google Scholar 

  4. Clasen DC, Burke JP, Ford CD, Evershed S, Aloia MR, Wilfahrt JK, Elliott JA (1990)Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis. Am J Med 89: 441–446

    PubMed  Google Scholar 

  5. Cohen J, Donnelly JP, Worsley AM, Catovsky D, Goldman JM, Galton DAG (1983) Septicaemia caused by viridans streptococci in neutropenic patients with leukaemia. Lancet 2: 1452–1454

    PubMed  Google Scholar 

  6. Dekker AW, Rozenberg-Arska M, Sixma JJ, Verhoef J (1981) Prevention of infection by trimethoprim-sulfamethoxazole plus amphotericin B in patients with acute nonlymphocytic leukemia. Ann Intern Med 95: 555–559

    PubMed  Google Scholar 

  7. Dekker AW, Rozenberg-Arska M, Verhoef J (1987) Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med 106: 7–12

    PubMed  Google Scholar 

  8. EORTC International Antimicrobial Therapy Project Group (1984) Trimethoprim-sulfamethoxazole in the prevention of infection in neutropenic patients. J Infect Dis 150: 372–379

    Google Scholar 

  9. Goldfarb J, Wormser GP, Glaser JH (1984) Meningitis caused by multiple antibiotic-resistant viridans streptococci. J Pediatr 105: 891–895

    PubMed  Google Scholar 

  10. Groot-Loonen JJ, van der Nordaa J, de Kraker J, Voute PA, van Leeuwen EF, Terpstra WJ, Ansink-Schipper MC (1987) α-hemolytic streptococcal septicemia with severe complications during neutropenia in childhood cancer. Pediatr Hematol Oncol 4: 323–328

    PubMed  Google Scholar 

  11. Guiot HFL, van Furth R (1977) Partial antibiotic decontamination. Br Med J 1: 800–802

    Google Scholar 

  12. Guiot HFL, van den Broek PJ, van der Meer JWM, van Furth R (1983) Selective antimicrobial modulation of the intestinal flora of patients with acute nonlymphocytic leukemia: a double-blind, placebo-controlled study. J Infect Dis 147: 615–623

    PubMed  Google Scholar 

  13. Guiot HFL, Helmig-Schurter AV, van der Meer JWM, van Furth R (1986) Selective antimicrobial modulation of the intestinal microbial flora for infection prevention in patients with hematologic malignancies. Evaluation of clinical efficacy and the value of surveillance cultures. Scand J Infect Dis 18: 153–160

    PubMed  Google Scholar 

  14. Guiot HFL, van den Broek PJ, van der Meer JWM, Peters WG, Willemze R, van Furth R (1988) The association between streptococcal infection and interstitial pneumonitis in chemotherapy and BMT. Bone Marrow Transplant 3 [Suppl 1]: 274

    Google Scholar 

  15. Guiot HFL, van Furth R (1989) Infection prevention by modulation of the host flora. In: Jackson GG, Schlumberger HD, Zeiler HJ (eds) Perspectives in antiinfective therapy. Bayer Centenary Symposium, Washington, D.C., Aug. 31 — Sept. 3, 1988. Springer, Berlin Heidelberg New York, pp 285–294

    Google Scholar 

  16. Guiot HFL, Peters WG, van den Broek PJ, van der Meer JWM, Kramps JA, Willemze R, van Furth R (1990) Respiratory failure elicited by streptococcal septicemia in patients treated with cytosine arabinoside, and its prevention by penicillin. Infection 18: 131–137

    PubMed  Google Scholar 

  17. Henslee J, Bostrom B, Weisdorf D, Ramsay N, McGlave P, Kersey J (1984) Streptococcal sepsis in bone marrow transplant patients. Lancet 1: 393

    Google Scholar 

  18. Kern W, Kurrle E, Schmeiser T (1990) Streptococcal bacteremia in adult patients with leukemia undergoing aggressive chemotherapy. A review of 55 cases. Infection 18: 138–145

    PubMed  Google Scholar 

  19. Mascret B, Maraninchi D, Gastaut JA, Novakovitch G, Sebahoun G, Meyer G, Carcassone Y (1984) Risk factors for streptococcal septicaemia after marrow transplantation. Lancet 1: 1185–1186

    Google Scholar 

  20. Pauw De BE, Donelly JP, De Witte T, Novakova IRO, Schattenberg A (1990) Options and limitations of long-term oral ciprofloxacin as antibacterial prophylaxis in allogeneic bone marrow transplant recipients. Bone Marrow Transplant 5: 179–182

    PubMed  Google Scholar 

  21. Pizzo PA, Ladisch S, Witebsky FG (1978) α haemolytic streptococci: clinical significance in the cancer patient. Med Pediatr Oncol 4: 367–370

    PubMed  Google Scholar 

  22. Ringden O, Heimdahl A, Lönnqvist B, Malmborg A-S, Wilczek H (1984) Decreased incidence of viridans streptococcal septicaemia in allogeneic bone marrow transplant recipients after the introduction of acyclovir. Lancet 1: 744

    Google Scholar 

  23. Rozenberg-Arska M, Dekker A, Verdonck L, Verhoef J (1989) Prevention of bacteremia caused by α-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin. Infection 17: 240–244

    PubMed  Google Scholar 

  24. Steiner M, Villablanca J, Kersey J, Ramsay N, Ferrieri P, Haake R, Weisdorf D (1988) α-streptococcal shock in bone marrow transplantation patients. Blood 72 [Suppl 1]: 409 a (abstract)

    Google Scholar 

  25. Valteau D, Hartmann O, Brugieres L, Vassal G, Benhamou E, Andremont A, Kalifa C, Lemerle J (1991) Streptococcal septicaemia following autologous bone marrow transplantation in children with high-dose chemotherapy. Bone Marrow Transplant 7: 415–419

    PubMed  Google Scholar 

  26. Vendetti M, Baiocchi P, Santini C, Brandimarte C, Serra P, Gentile G, Girmenia C, Martino P (1989) Antimicrobial susceptibilities of streptococcus species that cause septicemia in neutropenic patients. Antimicrob Agents Chemother 33: 580–582

    PubMed  Google Scholar 

  27. Verhagen C, Stalpers LJA, de Pauw BE, Haanen C (1987) Drug-induced skin reactions in patients with acute non-lymphocytic leukaemia. Eur J Haematol 38: 225–230

    PubMed  Google Scholar 

  28. Villablanca JG, Steiner M, Kersey J, Ramsay NKC, Ferrieri P, Haake R, Weisdorf D (1990) The clinical spectrum of infections with viridans streptococci in bone marrow transplant patients. Bone Marrow Transplant 6: 387–393

    Google Scholar 

  29. Weisman SJ, Scoopo FJ, Johnson GM, Altman AJ, Quinn JJ (1990) Septicemia in pediatric oncology patients: the significance of viridans streptococcal infections. J Clin Oncol 8: 453–459

    PubMed  Google Scholar 

  30. Wells CL, Podzorski RP, Peterson PK, Ramsay NK, Simmons RL, Rhame FS (1984) Incidence of trimethoprim-sulfametho-xazole-resistant enterobacteriaceae among transplant recipients. J Infect Dis 150: 699–706

    PubMed  Google Scholar 

  31. Willemze R, Peters WG, van Hennik MB, Fibbe WE, Kootte AMM, van Berkel M, Lie R, Rodenburg CJ, Veltkamp J (1985) Intermediate and high-dose Ara-C and m-AMSA (or daunorubicin) as remission and consolidation treatment for patients with relapsed and acute leukaemia and lymphoblasdtic non-Hodgkin's lymphoma. Scand J Haematol 34: 83–87

    PubMed  Google Scholar 

  32. Willemze R, Jager U, Jehn U, Stryckmans P, Bury J, Suciu S, Solbu G, Zittoun R, Burghouts J, Löwenberg B, Abels J, Cauchie CH (1988) Intermediate and high-dose Ara-C and m-AMSA for remission induction and consolidation treatment of patients with acute myeloid leukemia: an EORTC Leukemia Cooperative Group phase-II study. Eur J Cancer Clin Oncol 24: 1721–1725

    PubMed  Google Scholar 

  33. Willemze R, Peters WG, Colly LP (1988) Short-term intensive treatment (V.A.A.P.) of adult acute lymphoblastic leukemia and lymphoblastic lymphoma. Eur J Hematol 41: 489–495

    Google Scholar 

  34. Zittoun R, Mandelli F, De Witte T et al. (1990) Allogeneic versus autologous BMT versus intensive consolidation in acute myelogenous leukemia in first remission. An EORTC/Gimema phase-III trial (LAM 8A). Blood 76 [Suppl 1]: 340

    Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Diseases, University Hospital of Leiden, The Netherlands

    H. F. L. Guiot, P. J. van den Broek & R. van Furth

  2. Department of Internal Medicine, University of Nijmegen, The Netherlands

    J. W. M. van der Meer

  3. Department of Hematology/BMT, University Hospital, Bldg. 1 C6-106, P.O. Box 9600, NL-2300-RC, Leiden, The Netherlands

    R. Willemze

Authors
  1. H. F. L. Guiot
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  2. J. W. M. van der Meer
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  3. P. J. van den Broek
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  4. R. Willemze
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  5. R. van Furth
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Guiot, H.F.L., van der Meer, J.W.M., van den Broek, P.J. et al. Prevention of viridans-group streptococcal septicemia in oncohematologic patients: A controlled comparative study on the effect of penicillin G and cotrimoxazole. Ann Hematol 64, 260–265 (1992). https://doi.org/10.1007/BF01695467

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  • DOI: https://doi.org/10.1007/BF01695467

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