Bacteremia by viridans group streptococci in children with leukemia: Epidemiology and variables associated with recurrence

Introduction: Infections caused by viridans group streptococci in pediatric oncology patients can be severe and are associated with high mortality. Objective. To describe the clinical, microbiological, and outcome characteristics of pediatric patients with viridans group streptococci bacteremia and acute leukemia in a highcomplexity hospital, and to identify variables associated with recurrence. Objective: To describe the clinical, microbiological, and outcome characteristics of pediatric patients with viridans group streptococci bacteremia and acute leukemia in a highcomplexity hospital, and to identify variables associated with recurrence. Materials and methods: We conducted a retrospective cohort study including patients aged 1 month to 18 years with acute leukemia and viridans group streptococci bacteremia between 2016 and 2022. Patients and episode characteristics were described, and a univariate analysis was performed comparing those with a single bacteremia episode to those with recurrent episodes. Results: A total of 108 episodes were identified, of which 85 (79%) were first or isolated episodes and 23 (21%) were recurrences. The median age was 68 months. Streptoccocus mitis and S. oralis were the most frequently identified species in both groups. Recurrent bacteremia was significantly associated with prior antibiotic use within the preceding 30 days, longer duration of prior antibiotic treatment, use of carbapenems, presence of acute gastroenteritis as the clinical focus of infection, and the consolidation phase of treatment. Conclusions: Viridans group streptococci bacteremia predominantly occurred in children with acute myeloid leukemia. Recurrence accounted for 21% of episodes and was associated with prior antibiotic exposure, gastroenteritis as the clinical focus, and the consolidation phase of chemotherapy.