Jooeun KWON, Dae Hyun LEE, George COBA, Annie TOPHAM, Misbahuddin SYED, Asha RAMSAKAL, John GREENE

Abiotrophia and Granulicatella Infections in Cancer Patients: A Single-Center Chart Review Study

Objectives: Nutritionally Variant Streptococci (NVS) comprise two primary genera that have been identified from human specimens, particularly the Abiotrophia and Granulicatella species. These infections are often complicated to manage due to the difficulty identifying these organisms, indolent course of disease, and variable resistance to common antimicrobial agents. The wide breadth of disease presentations involving these organisms has not been fully elucidated, particularly in the immunosuppressed cancer patient population. Method: We performed a retrospective chart review on 28 patients from an academic cancer center with positive NVS cultures, from January 2012 to July 2018. We reviewed patient characteristics, culture data, immunodeficiency status, response to antibiotic therapy, and outcomes of infection. Results: Of twenty-eight patients, fifteen patients developed bacteremia from either Abiotrophia or Granulicatella species, while thirteen patients had positive wound or body fluid cultures. Most patients with bacteremia had underlying hematologic malignancies and neutropenia. Patients with positive wound or body fluid cultures had an invasive procedure at the related site. Intravenous (IV) vancomycin was the most common agent used, and all but two patients were treated with multiple antibiotic regimens. Conclusions: Infections with NVS have been reported with a variety of clinically infectious presentations and should be considered in cancer patients with neutropenia or in patients who have undergone invasive procedures. Bacteremia was the most common complication, especially in the setting of hematologic malignancy and neutropenia. Focal body site infection was also a common complication related to invasive procedures in immunocompetent patients. Overall mortality was low and related to complications of septic shock. J Microbiol Infect Dis 2020; 10(2):89-97.

Keywords:

Abiotrophia, Granulicatella, bacteremia, cancer, neutropenic infection,

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1. Frenkel A and Hirsch W. Spontaneous development of L forms of streptococci requiring secretions of other bacteria or sulfhydryl compounds for normal growth. Nature 1961; 191: 728-30. 2. Ruoff KL. Nutritionally variant streptococci. Clin Microbiol Rev 1991; 4: 184-90. 3. Christensen JJ and Facklam RR. Granulicatella and Abiotrophia species from human clinical specimens. J Clin Microbiol 2001; 39: 3520-3. 4. Ramos JN, dos Santos LS, Vidal LM, et al. A case report and literature overview: Abiotrophia defectiva aortic valve endocarditis in developing countries. Infection 2014; 42: 579-84. 5. Senn L, Entenza JM, Greub G, et al. Bloodstream and endovascular infections due to Abiotrophia defectiva and Granulicatella species. BMC Infect Dis 2006; 6: 9. 6. Zenone T and Durand DV. Brain abscesses caused by Abiotrophia defectiva: complication of immunosuppressive therapy in a patient with connective-tissue disease. Scand J Infect Dis 2004; 36: 497-9. 7. Hepburn MJ, Fraser SL, Rennie TA, Singleton CM, Delgado B. Septic arthritis caused by Granulicatella adiacens: diagnosis by inoculation of synovial fluid into blood culture bottles. Rheumatol Int 2003; 23: 255-7. 8. Yacoub AT, Krishnan J, Acevedo IM, Halliday J, Greene JN. Nutritionally variant streptococci bacteremia in cancer patients: a retrospective study, 1999-2014. Mediterr J Hematol Infect Dis 2015; 7: e2015030. 9. Koh YR, Yi J, Kim HH, Chang CL, Kim SY. Discrepant Satellitism for Identification of Granulicatella adiacens Isolates. Annals of Laboratory Medicine 2014; 34: 174-176. 10. De Luca M, Amodio D, Chiurchiu S, et al. Granulicatella bacteraemia in children: two cases and review of the literature. BMC Pediat. 2013; 13: 61. 11. Okada Y, Kitada K, Takagaki M, Ito HO, and Inoue M. Endocardiac infectivity and binding to extracellular matrix proteins of oral Abiotrophia species. FEMS Immunology & Medical Microbiology 2000; 27: 257-261. 12. Sato ST, Kanamoto T and Inoue M. Abiotrophia elegans strains comprise 8% of the nutritionally variant streptococci isolated from the human mouth. J Clin Microbiol 1999; 37: 2553-6. 13. Mvelase NR, Marajh K, Hattingh O, and Mlisana KP. An unusual case of thoracic empyema caused by Granulicatella elegans (nutritionally variant streptococci) in a patient with pulmonary tuberculosis and human immunodeficiency virus infection. JMM Case Rep 2016; 3: e005058. 14. Kanamaru A and Tatsumi Y. Microbiological Data for Patients with Febrile Neutropenia. Clinical Infectious Diseases 2004; 39: (S7-10). 15. Murray CK, Walter EA, Crawford S, McElmeel ML, and Jorgensen JH. Abiotrophia bacteremia in a patient with neutropenic fever and antimicrobial susceptibility testing of Abiotrophia isolates. Clin Infect Dis 2001; 32: E140-2. 16. Sonis ST, Elting LS, Keefe D, et al. Perspectives on cancer therapy‐induced mucosal injury. Cancer 100: 1995-2025. doi:10.1002/cncr.20162 17. del Pozo JL, Garcia-Quetglas E, Hernaez S, et al. Granulicatella adiacens breast implant-associated infection. Diagn Microbiol Infect Dis 2008; 6: 58-60. 18. Rozemeijer W, Jiya TU, Rijnsburger M, Heddema E, Savelkoul P, and Ang W. Abiotrophia defectiva infection of a total hip arthroplasty diagnosed by 16S rRNA gene sequencing. Diagn Microbiol Infect Dis 2011; 70: 142-4. 19. Casalta JP, Habib G, La Scola B, Drancourt M, Caus T, and Raoult, D. Molecular Diagnosis of Granulicatella elegans on the Cardiac Valve of a Patient with Culture-Negative Endocarditis. Journal of Clinical Microbiology 2002; 40: 1845-1847. 20. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132: 1435-86. 21. Prasidthrathsint K, and Fisher MA. Antimicrobial Susceptibility Patterns among a Large, Nationwide Cohort of Abiotrophia and Granulicatella Clinical Isolates. J Clin Microbiol 2017; 55: 1025-1031. 22. O'Grady NP, Alexander M, Burns LA, et al. Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clinical Infectious Diseases 2011; 52: 1087-1099. 23. Cargill JS, Scott KS, Gascoyne-Binzi D, Sandoe JA. Granulicatella infection: diagnosis and management. J Med Microbiol 2012; 61(6): 755-61. 24. Ratcliffe P, Fang H, and Thidholm E. Comparison of MALDI-TOF MS and VITEK 2 System for Laboratory Diagnosis of Granulicatella and Abiotrophia Species Causing Invasive Infections. Diagnostic Microbiology and Infectious Disease 2013; 77: 216-219.