BACTEREMIA DUE TO GRAM-POSITIVE COCCI IN PATIENTS WITH NEOPLASTIC DISEASE

Fifty-seven bacteremias caused by gram-positive cocci were observed over a four and a half year period in patients with a wide variety of malignant diseases. All patients had two or more positive antemortem blood cultures with the same microorganism. The number of bacteremic episodes were divided between Streptococcus pneumoniae (14), other streptococci (17) and Staphylococcus aureus (26). Seventy per cent, including 50 per cent of the pneumococcal bacteremias, were nosocomial. An identifiable portal of bacterial entry in the skin or the gastrointestinal or respiratory tract mucosa was present in 95 per cent, fever in 81 per cent and a prebacteremic performance status of less than 2 in 53 per cent. Granulocytopenia was present in only 18 per cent of the cases at the onset of the bacteremia. These bacteremias appeared to be responsive to antimicrobial therapy with an over-all immediate mortality rate of 23 per cent; 16 per cent in adequately treated patients. Poor outcome was associated with a prebacteremic performance status of 3 or 4, other than optimal antimicrobial therapy, a neutrophil count of less than 1,000/mm3 at the onset of the infection, and bacteremia due to Strep, pneumoniae. Hospitalized cancer patients, especially those with a poor performance status, should be monitored closely for breaks in the mucocutaneous host defense barriers and, if these are present in the face of suspected systemic infection, initial antimicrobial therapy should include drugs appropriate for the treatment of gram-positive coccal microorganisms. © 1979.