INTRODUCTION
Viridans group streptococci (VGS) are an important cause of bacteraemia
in children with cancer.1-4 VGS bloodstream infection
(VGS-BSI) can rapidly progress to cause a toxic shock-like syndrome
characterised by hypotension and acute respiratory distress
syndrome,5-7 with mortality of up to 23% in
children.5,7,8 Groups at highest risk of VGS-BSI
include children with acute myeloid leukaemia (AML),4relapsed acute lymphoblastic leukaemia (ALL),9 infant
ALL,10 and those undergoing haematopoietic stem cell
transplant (HSCT).11
VGS-BSI associated mortality, coupled with a rise in
penicillin-resistance amongst VGS isolates,12 has led
to advocacy for the addition of empiric vancomycin to treat febrile
neutropaenia in high-risk children.13 However,
recommendations differ between guidelines and practice varies between
centres.14,15 At our institution, the addition of
empiric vancomycin for the initial management of febrile neutropaenia is
recommended in patients at highest-risk of VGS-BSI. We aimed to assess
the safety and efficacy of this risk-stratified approach by examining
the epidemiology, microbiology, and outcomes of VGS-BSI at our centre.