Reactions 1680, p107 - 2 Dec 2017
Bacteraemia due to Enterococcus raffinosus and
Leuconostoc lactis and febrile neutropenia: case
A 44-year-old woman developed gram-positive cocci
bacteraemia and febrile neutropenia during treatment with
cytarabine and idarubicin [dosages, routes and time to reaction
onset not stated].
The woman, who was hospitalised with fever, fatigue and
white blood cell count of 1.4 X 10
/L with 2.5% blasts and
41.5% neutrophils, was diagnosed with acute myeloid
leukaemia with myelodysplasia-related changes. She was
started on treatment with cytarabine and idarubicin.
The woman was started on cefepime for febrile neutropenia,
which was replaced by meropenem and later again replaced by
doripenem. However, her febrile neutropenia was persistent.
Gradually, she also developed abdominal pain and diarrhoea.
On day 13 of induction chemotherapy, blood culture was
found positive for Enterococcus raffinosus. Bacterial
translocation from the gastrointestinal tract was suspected
based on clinical symptoms. She was started on teicoplanin
and dosage was adjusted according to the trough levels. But
her fever, diarrhoea and abdominal pain persisted, despite
negative blood culture results. On day 19, blood culture were
again positive for gram-positive cocci. Severe bloodstream
infection by glycopeptide-resistant gram-positive cocci was
suspected. She was started on daptomycin instead of
teicoplanin and Leuconostoc lactis infection was detected by
using mass spectrometry. Bacteraemia due to Enterococcus
raffinosus and Leuconostoc lactis was controlled by
daptomycin. Since day 21, blood cultures were found negative
and clinical improvement was observed. Daptomycin was
stopped on day 39, after which complete remission of acute
myeloid leukaemia and neutrophil recovery was achieved.
Author comment: "Bacteremia during chemotherapy is a
life-threatening event, because chemotherapy frequently
induces neutropenia." "A 44-year-old woman with acute
myeloid leukemia (AML) under myelosuppression suffered
from teicoplanin-resistant gram-positive cocci
bacteremia. . .Taking severe neutropenia due to
chemotherapy and glycopeptide-resistance into account,
teicoplanin was empirically substituted with daptomycin,
which led to prompt defervescence."
Matsuda K, et al. A therapeutic benefit of daptomycin against glycopeptide-
resistant gram-positive cocci bloodstream infections under neutropenia. Journal of
Infection and Chemotherapy 23: 788-790, No. 11, Nov 2017. Available from:
URL: http://doi.org/10.1016/j.jiac.2017.06.010 - Japan
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved