Clinical Analysis Of Blood Stream Infection Of Streptococcus Mitis With Hematological Malignancies

Objective: This paper aims to investigate the risk factors,clinical manifestations,treatment,and prognosis of blood stream infection(BSI)of Streptococcus mitis with hematological malignancies(HM),and to analyze the characteristics of drug sensitivity of Streptococcus mirabilis,thus strengthening clinicians’ understanding of the disease,and providing reference basis for clinicians’ early diagnosis,treatment and clinical intervention.Methods: 11 patients with malignant hematological diseases complicated with chronic streptococcal bloodstream infection from January 2012 to July2019,who were hospitalized and treated in the first affiliated Hospital of Guangxi Medical University,were analyzed retrospectively.The clinical characteristics,drug sensitivity test results,treatment regimen and disease outcome were summarized,and the susceptible factors were analyzed.Methods: Through analyzing retrospectively 11 cases with malignant hematological diseases complicated with chronic streptococcal bloodstream infection from January 2012 to July 2019,who were hospitalized and treated in the first affiliated Hospital of Guangxi Medical University,this paper summarized the clinical characteristics,drug sensitivity test results,treatment regimen and disease outcome,and analyzed the susceptible factors.Results: 1.Clinical features: the initial symptoms of 11 patients were fever,whose highest body temperature was 38.5 ℃-41.0 ℃,and the average highest body temperature was 39.6 ℃.Among them,8 cases were accompanied by chills,accounting for 72.7%(8/11).All the 11 cases had identifiable clinical infection lesions,mainly in the lungs and oropharynx,including suppurative tonsillitis(27.2%),oral ulcer(63.6%)and pneumonia(90.9%).The chest CT of patients with pneumonia showed patchy shadow of the lungs.Other manifestations included rash in 2 cases,and diarrhea in 1 cases.2.Susceptible factors: 1)Granulocytopenia(agranulocytosis): 11 patients were in the stage of agranulocytosis before the occurrence of streptococcal bloodstream infection,the lowest value of neutrophils was 0-0.05 × 109 / L(the average lowest value was 0.013 × 109),and the time of neutropenia was 7d-15d(the average time of neutropenia was 10.3 days).2)Use of prophylactic broad-spectrum antibiotics:all the 11 patients had prophylactic use of antibiotics before infection.3)The hospitalization time was long,: and the hospitalization time of 11 patients before infection was 12d-36d(the average hospitalization time was 20.1 days).4)Invasive operation: deep venous catheterization via peripheral vein was indwelled in 8 of 11 patients,accounting for 72.7%(8 / 11).5)Oral mucosal damage: oral ulcer occurred in 8 of the 11 patients,with an incidence of 63.6%(7 to 11).3.The results of drug sensitivity test: the sensitive rates of strains isolated in this study to linezolid,vancomycin,levofloxacin,chloramphenicol,penicillin,ceftriaxone,erythromycin,clindamycin,and tetracycline were 100%,100%,100%,60%,81.2%,40%,63.6% and 33.3%,respectively.4.Treatment and outcome: 11 patients with malignant hematological diseases complicated with streptococcal blood flow infection were treated with tegacycline +cefoperazone sulbactam,carbapenem(2 cases),piperacillin/ tazobactam(1 case),vancomycin+piperacillin/tazobactam(1 case),vancomycin + piperacillin /tazobactam(1 case).After the return of blood culture,3 cases were treated with tegacycline + cefoperazone sulbactam,5 cases were treated with carbapenem alone,and 1 case was treated with vancomycin + piperacillin / tazobactam.One case was converted to linezolid + piperacillin / tazobactam.The recovery time of body temperature in 11 patients after switching to antibiotics was 2d-8d(the average was 3.8 days),and the total course of antibiotic treatment was 9d-23d(the average was 12.6 days).11 patients showed signs of improvement were improved after treatment,and their follow-up was 2-12 months(the average was6 months).No streptococcal infection reoccurred.Conclusion: As regards the clinical characteristics of malignant hemat ological diseases complicated with chronic streptococcal bloodstream infect ion,the initial symptom was fever,often accompanied by oral mucosal ul cer and respiratory symptoms,and its susceptible factors were agranulocyt osis,oral mucosal damage,the use of prophylactic broad-spectrum antibiot ics,long-term hospitalization and invasive operation.Vancomycin,linezolid and carbapenem were sensitive to streptococcus mirabilis and effective aga inst it,which could be used as empirical drugs.