Septicemia and Shock Syndrome Due to Viridans Streptococci: A Case-Control Study of Predisposing Factors

摘要: Between 1972 and 1989, the incidence of viridans streptococcal bacteremia at University Texas M. D. Anderson Cancer Center in Houston increased from one case per 10,000 admissions to 47 cases (P less than .0001). A shock syndrome characterized by hypotension, rash, palmar desquamation, adult respiratory distress syndrome, occasionally death developed 26% septicemia but only 4% involving other gram-positive bacteria = .0005). The risk infection with prophylactic administration trimethoprim-sulfamethoxazole or a fluoroquinolone .0001) profound neutropenia Treatment chemotherapy-induced gastritis antacids histamine type 2 (H2) antagonists was associated sevenfold increase .001), while sucralfate therapy did not .65). Streptococcal may result gastric overgrowth organisms resistant an antacid- H2 antagonist-induced alkaline environment, gastrointestinal tract ulceration caused antineoplastic providing convenient portal entry. In patients receiving chemotherapy, replacement acid-sparing regimen should be considered preserve natural acidic barrier infection.