From December 1976 through October 1986, there were 18 episodes of septicemia in 48 children with leukemia and lymphoma at Asahikawa Medical College, Department of Pediatrics. Twenty infectious agents were isolated, and eleven of the organisms isolated (55%) were gram-positive cocci. The most common gram-positive cocci causiog sepsis were streptococcus viridans, staphylococcus aureus, and streptococcus pneumonia. On the other hand, gram-negative bacilii were isolated from only six of our patients. Only 3 of the 10 episodes of exclusively gram-positive septicemia were fatal, whereas 5 of 5 episodes of exclusively gram-negative septicemia were fatal.
All of the patients who developed septicemia caused by streptococci, had been receiving a combination with Cytosine arabinoside or Behenoyl-AraC. It is suspected that oral and gastrointestinal ulceration caused by cytotoxic chemotherapy provided a portal of entry for the streptococci.
The increasing incidence of infections with gram-positive organisms as a complication of hematologic malignancies prompts a reconsideration of the current empirical antimicrobial therapy.
