Reactions 1680, p107 - 2 Dec 2017 Bacteraemia due to Enterococcus raffinosus and Leuconostoc lactis and febrile neutropenia: case report 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 803285628 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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