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.