Neuroinvasive Bacillus cereus Infection in Immunocompromised Hosts: Epidemiologic Investigation of 5 Patients With Acute Myeloid Leukemia.
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Little Jessica S, Coughlin Cassie, Hsieh Candace, Lanza Meaghan, Huang Wan Yi, Kumar Aishwarya, Dandawate Tanvi, Tucker Robert, Gable Paige, Vazquez Deida Axel A, Moulton-Meissner Heather, Stevens Valerie, McAllister Gillian, Ewing Thomas, Diaz Maria, Glowicz Janet, Winkler Marisa L, Pecora Nicole, Kubiak David W, Pearson Jeffrey C, Luskin Marlise R, Sherman Amy C, Woolley Ann E, Brandeburg Christina, Bolstorff Barbara, McHale Eileen, Fortes Esther, Doucette Matthew, Smole Sandra, Bunnell Craig, Gross Anne, Platt Dana, Desai Sonali, Fiumara Karen, Issa Nicolas C, Baden Lindsey R, Rhee Chanu, Klompas Michael, Baker Meghan A
Аннотация
METHODS: A single-center retrospective review was conducted to evaluate patients with acute leukemia, positive blood or cerebrospinal fluid test results for B cereus, and abnormal neuroradiographic findings between January 2018 and October 2022. Infection control practices were observed, environmental samples obtained, a dietary case-control study completed, and whole genome sequencing performed on environmental and clinical Bacillus isolates.
RESULTS: Five patients with B cereus neuroinvasive disease were identified. All patients had acute myeloid leukemia (AML), were receiving induction chemotherapy, and were neutropenic. Neurologic involvement included subarachnoid or intraparenchymal hemorrhage or brain abscess. All patients were treated with ciprofloxacin and survived with limited or no neurologic sequelae. B cereus was identified in 7 of 61 environmental samples and 1 of 19 dietary protein samples-these were unrelated to clinical isolates via sequencing. No point source was identified. Ciprofloxacin was added to the empiric antimicrobial regimen for patients with AML and prolonged or recurrent neutropenic fevers; no new cases were identified in the ensuing year.
CONCLUSIONS: B cereus is ubiquitous in the hospital environment, at times leading to clusters with unrelated isolates. Fastidious infection control practices addressing a range of possible exposures are warranted, but their efficacy is unknown and they may not be sufficient to prevent all infections. Thus, including B cereus coverage in empiric regimens for patients with AML and persistent neutropenic fever may limit the morbidity of this pathogen.