View source for Streptococcus bacteremia

{{DISPLAYTITLE:''Streptococcus'' bacteremia}}

== Background ==

* [[Bacteremia]] caused by [[streptococci]]

=== Risk of Infective Endocarditis ===
* Among all patients with [[Streptococcus]] bacteremia, the prevalence of [[infective endocarditis]] is about 7%[[CiteRef::chamat-hedemand2020pr]]
**This varies greatly by species, with the highest-risk species being [[Streptococcus gallolyticus]] and three [[Viridans group streptococci]], [[Streptococcus sanguinis]], [[Streptococcus gordonii]], and [[Streptococcus mutans]]

{| class="wikitable sortable mw-collapsible"
!Group
!Species
!Risk of IE
!Number of BSIs
|-
|[[Group A Streptococcus]]
|[[Streptococcus pyogenes]]
| style="color:darkgreen" |1.9%
| style="color:darkgreen" |592
|-
|[[Group B Streptococcus]]
|[[Streptococcus agalactiae]]
| style="color:goldenrod" |9.1%
| style="color:goldenrod" |441
|-
|[[Group C Streptococcus]]
|[[Streptococcus equi]]
| style="color:darkgreen" |0
| style="color:darkgreen" |<4
|-
|[[Group C Streptococcus|Group C]] or [[Group G Streptococcus|G Streptococcus]]
|[[Streptococcus dysgalactiae]]
| style="color:goldenrod" |6.6%
| style="color:goldenrod" |901
|-
| rowspan="3" |[[VGS]], [[Streptococcus anginosus group]]
|[[Streptococcus anginosus]]
| style="color:goldenrod" |4.8%
| style="color:goldenrod" |437
|-
|[[Streptococcus constellatus]]
| style="color:goldenrod" |<4%
| style="color:goldenrod" |91
|-
|[[Streptococcus intermedius]]
| style="color:darkgreen" |0%
| style="color:darkgreen" |40
|-
| rowspan="3" |[[VGS]], [[Streptococcus mitis group]]
|[[Streptococcus mitis]] or [[Streptococcus oralis|oralis]]
| style="color:darkred" |19.4%
| style="color:darkred" |408
|-
|'''[[Streptococcus cristatus]] or [[Streptococcus sinensis|sinensis]]'''
| style="color:darkred" |'''44%'''
| style="color:darkred" |'''9'''
|-
|[[Streptococcus peroris]]
| style="color:darkgreen" |0
| style="color:darkgreen" |10
|-
| rowspan="3" |[[VGS]], [[Streptococcus sanguinis group]]
|'''[[Streptococcus gordonii]]'''
| style="color:darkred" |'''44.2%'''
| style="color:darkred" |'''95'''
|-
|'''[[Streptococcus sanguinis]]'''
| style="color:darkred" |'''34.6%'''
| style="color:darkred" |'''133'''
|-
|[[Streptococcus parasanguinis]]
| style="color:darkred" |10.3%
| style="color:darkred" |107
|-
| rowspan="3" |[[VGS]], [[Streptococcus salivarius group]]
|[[Streptococcus salivarius]]
| style="color:goldenrod" |5.8%
| style="color:goldenrod" |191
|-
|[[Streptococcus vestibularis]]
| style="color:goldenrod" |low
| style="color:goldenrod" |26
|-
|[[Streptococcus thermophilus]]
| style="color:goldenrod" |<4%
| style="color:goldenrod" |45
|-
| rowspan="2" |[[VGS]], [[Streptococcus mutans group]]
|'''[[Streptococcus mutans]]'''
| style="color:darkred" |'''47.9%'''
| style="color:darkred" |'''48'''
|-
|[[Streptococcus sobrinus]]
| style="color:darkgreen" |0
| style="color:darkgreen" |<4
|-
| rowspan="2" |[[Nutritionally variant streptococci]]
|[[Granulicatella adiacens]]
| style="color:darkred" |12.2%
| style="color:darkred" |41
|-
|[[Granulicatella elegans]]
| style="color:darkgreen" |0
| style="color:darkgreen" |5
|-
| rowspan="5" |[[Streptococcus bovis group]]
|'''[[Streptococcus gallolyticus]]'''
| style="color:darkred" |'''30.7%'''
| style="color:darkred" |'''225'''
|-
|[[Streptococcus lutetiensis]]
| style="color:goldenrod" |low
| style="color:goldenrod" |23
|-
|[[Streptococcus infantarius]]
| style="color:darkred" |low
| style="color:darkred" |14
|-
|[[Streptococcus equinus]]
| style="color:darkred" |low
| style="color:darkred" |12
|-
|[[Streptococcus alactolyticus]]
| style="color:darkgreen" |0
| style="color:darkgreen" |<4
|-
|
|[[Streptococcus pneumoniae]]
| style="color:darkgreen" |1.2%
| style="color:darkgreen" |2,598
|-
|
|[[Streptococcus massiliensis]]
| style="color:darkgreen" |0
| style="color:darkgreen" |5
|-
|
|[[Streptococcus pluranimalium]]
| style="color:darkgreen" |0
| style="color:darkgreen" |<4
|-
|
|[[Streptococcus suis]]
| style="color:darkgreen" |0
| style="color:darkgreen" |<4
|}

* Other risk factors include ≥3 positive BC bottles, prosthetic valve, native valve disease, cardiac device, previous endocarditis, and male sex (in descending order of important)

== Investigations ==

* For non-β-hemolytic streptococci, consider using the [[HANDOC score]] to risk stratify for need for [[echocardiography]]
**Can effectively exclude the diagnosis of IE without needing imaging
*Alternatively, can use an approach based on species, number of positive blood culture bottles, and presence of risk factors (native valve disease, previous IE, prosthetic valve, or cardiac device)[[CiteRef::chamat-hedemand2020pr]]
{| class="wikitable sortable"
! rowspan="2" |Risk
! rowspan="2" |Species
! colspan="2" |<3 Bottles
! colspan="2" |≥3 Bottles
|-
!No RFs
!RFs
!No RFs
!RFs
|-
| rowspan="3" |low
|[[Streptococcus intermedius]]
| colspan="3" rowspan="3" |no echo
| rowspan="3" |TTE
|-
|[[Streptococcus pneumoniae]]
|-
|[[Streptococcus pyogenes]]
|-
| rowspan="6" |moderate
|[[Streptococcus agalactiae]]
| rowspan="6" |no echo
| colspan="2" rowspan="6" |TTE
| rowspan="6" |TTE+TEE
|-
|[[Streptococcus anginosus]]
|-
|[[Streptococcus constellatus]]
|-
|[[Streptococcus dysgalactiae]]
|-
|[[Streptococcus salivarius]]
|-
|[[Streptococcus thermophilus]]
|-
| rowspan="3" |high
|[[Granulicatella adiacens]]
| rowspan="3" |TTE
| colspan="3" rowspan="3" |TTE+TEE
|-
|[[Streptococcus mitis]]/[[Streptococcus oralis|oralis]]
|-
|[[Streptococcus parasanguinis]]
|-
| rowspan="4" |very high
|[[Streptococcus gallolyticus]]
| colspan="4" rowspan="4" |TTE+TEE
|-
|[[Streptococcus gordonii]]
|-
|[[Streptococcus mutans]]
|-
|[[Streptococcus sanguinis]]
|}
[[Category:Bacteremias]]