α-Streptococcal Sepsis in Childhood Hematologic Disease

Abstract

In all neutropenic patients with hematologic disease, selective decontamination of the digestive tract was instituted by oral administration of a nonabsorbable antimicrobial drug, polymyxin B (PLB), to decrease the gram-negative rods. During a 12 year period, from 1983 to 1994, the Department of Pediatrics, Chiba University School of Medicine diagnosed 32 episodes (23%) of a-streptococcal (α-Str) sepsis out of 142 positive blood cultures in children with hematologic disease, indicating that α-Str was one of the most frequent pathogens of sepsis in that period. All 32 episodes occurred at neutrophil counts of less than 100/μ1. Streptococcus mitis was the predominant type isolated from the blood cultures. Three patients died of intracranial hemorrhaging and one of septic shock. The other 28 cases, including six patients who developed interstitial pneumonia, were cured. The careful selection of antimicrobial drugs is important since some of the isolated strains showed a high minimal inhibitory concentration (MIC) against penicillins and first-generation cephems. Empiric antimicrobial therapy for febrile and neutropenic patients with hematological diseases should include antibiotics effective against α-Str.