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Febrile Neutropenia — SCE Infectious Diseases MCQ

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HardImmunocompromised HostFebrile NeutropeniaSCE Infectious Diseases

A 45-year-old man undergoing autologous stem cell transplant develops severe mucositis with oral ulceration. Blood cultures grow Streptococcus mitis (viridans group streptococcus). He is neutropenic and febrile. MIC to Benzylpenicillin is 4 mg/L (resistant). He becomes hypotensive. What is the most appropriate antibiotic?

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Correct answer: D — Vancomycin IV

Viridans group streptococcal bacteraemia is a recognised complication of chemotherapy-related mucositis. Penicillin-resistant strains (MIC >2 mg/L) are increasingly common. In a neutropenic, septic patient with penicillin-resistant viridans streptococcal bacteraemia, IV Vancomycin is the treatment of choice. Viridans group streptococcal shock syndrome carries significant mortality. Source control (mucositis management) is also important.

Reference: ECIL-4 2018 – Febrile neutropenia guidelines; BSAC 2023 – Bacteraemia guidelines