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Predictors of Viridans Streptococcal Shock Syndrome in Bacteremic Children With Cancer and Stem-Cell Transplant Recipients

From the Divisions of Hematology/Oncology and Infectious Disease, Department of Pediatrics, and Departments of Microbiology and Laboratory Medicine and Pharmacy, Hospital for Sick Children, Toronto, Ontario, Canada.

Address reprint requests to Lillian Sung, MD, Division of Hematology/Oncology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8 Canada; e-mail: Lillian.sung{at}sickkids.ca

PURPOSE: To describe episodes of viridans streptococcal bacteremia (VSB) in a cohort of children with cancer and stem-cell transplant (SCT) recipients and to determine predictors of viridans streptococcal shock syndrome (VSSS) in this group of children.

PATIENTS AND METHODS: For this retrospective review, we included episodes of VSB isolated between March 1997 and September 2002, in children ( 18 years) with a diagnosis of cancer or SCT patients. The primary outcome was VSSS, defined as hypotension requiring intravascular volume expansion or inotropic support and/or respiratory insufficiency necessitating assisted ventilation.

RESULTS: Eighty-eight episodes of VSB occurred in 79 children. The mean age of the children was 6.7 years (range, 0.6 to 18.0 years). The most common underlying diagnosis was acute myelogenous leukemia (AML) in 31 (35%) of 88 episodes, and 38 (43%) of 88 had undergone SCT. VSSS occurred in 16 (18%) of 88 episodes, and two children died from VSSS. Two variables were predictive of VSSS, namely peak temperature at presentation (odds ratio [OR], 6.3; 95% CI, 2.1 to 19.0; P = .001) and inpatient status (OR, 5.9; 95% CI, 1.3 to 28.0; P = .02). Diagnosis of AML (OR, 1.1; 95% CI, 0.4 to 3.5; P = .8), receipt of SCT (OR, 1.9; 95% CI, 0.6 to 5.7; P = .2), high-dose cytarabine (OR, 0.6; 95% CI, 0.1 to 3.2; P = .6), and mucositis (OR, 0.8; 95% CI, 0.3 to 2.6; P = .7) were not predictive of VSSS.

CONCLUSION: VSSS occurred in 18% of episodes of VSB in children with cancer or SCT recipients. Peak temperature before antibiotic therapy and inpatient status were predictive of VSSS.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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