Streptococcus bacteremia: Difference between revisions

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


== Background ==
== Risk Stratification: HANDOC ==


* [[Bacteremia]] caused by [[streptococci]]
* Risk stratified for [[endocarditis]] that has been validated in a Swedish cohort [[CiteRef::sunnerhagen2017ha]]

* Criteria:
=== Risk of Infective Endocarditis ===
** Heart murmur or valve disease
** Aetiology with the groups of [[Streptococcus mutans]], [[Streptococcus bovis]], [[Streptococcus sanguinis]], or [[Streptococcus anginosus]]
* 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]]
** Number of positive blood cultures ≥2

** Duration of symptoms of 7 days or more
{| class="wikitable sortable mw-collapsible"
** Only 1 species growing in blood cultures
!Group
** Community-acquired infection
!Species
* Interpretation:
!Risk of IE
** Score <3, IE is effectively excluded
!Number of BSIs
** Score ≥3, cannot exclude IE
|-
|[[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
|-
| rowspan="4" |Other streptococci
|[[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]]

Latest revision as of 15:02, 27 August 2024


Background

Risk of Infective Endocarditis

Group Species Risk of IE Number of BSIs
Group A Streptococcus Streptococcus pyogenes 1.9% 592
Group B Streptococcus Streptococcus agalactiae 9.1% 441
Group C Streptococcus Streptococcus equi 0 <4
Group C or G Streptococcus Streptococcus dysgalactiae 6.6% 901
VGS, Streptococcus anginosus group Streptococcus anginosus 4.8% 437
Streptococcus constellatus <4% 91
Streptococcus intermedius 0% 40
VGS, Streptococcus mitis group Streptococcus mitis or oralis 19.4% 408
Streptococcus cristatus or sinensis 44% 9
Streptococcus peroris 0 10
VGS, Streptococcus sanguinis group Streptococcus gordonii 44.2% 95
Streptococcus sanguinis 34.6% 133
Streptococcus parasanguinis 10.3% 107
VGS, Streptococcus salivarius group Streptococcus salivarius 5.8% 191
Streptococcus vestibularis low 26
Streptococcus thermophilus <4% 45
VGS, Streptococcus mutans group Streptococcus mutans 47.9% 48
Streptococcus sobrinus 0 <4
Nutritionally variant streptococci Granulicatella adiacens 12.2% 41
Granulicatella elegans 0 5
Streptococcus bovis group Streptococcus gallolyticus 30.7% 225
Streptococcus lutetiensis low 23
Streptococcus infantarius low 14
Streptococcus equinus low 12
Streptococcus alactolyticus 0 <4
Other streptococci Streptococcus pneumoniae 1.2% 2,598
Streptococcus massiliensis 0 5
Streptococcus pluranimalium 0 <4
Streptococcus suis 0 <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)1
Risk Species <3 Bottles ≥3 Bottles
No RFs RFs No RFs RFs
low Streptococcus intermedius no echo TTE
Streptococcus pneumoniae
Streptococcus pyogenes
moderate Streptococcus agalactiae no echo TTE TTE+TEE
Streptococcus anginosus
Streptococcus constellatus
Streptococcus dysgalactiae
Streptococcus salivarius
Streptococcus thermophilus
high Granulicatella adiacens TTE TTE+TEE
Streptococcus mitis/oralis
Streptococcus parasanguinis
very high Streptococcus gallolyticus TTE+TEE
Streptococcus gordonii
Streptococcus mutans
Streptococcus sanguinis

References

  1. ^  Torgny Sunnerhagen, Amanda Törnell, Maria Vikbrant, Bo Nilson, Magnus Rasmussen. HANDOC: A Handy Score to Determine the Need for Echocardiography in Non-β-Hemolytic Streptococcal Bacteremia. Clinical Infectious Diseases. 2017;66(5):693-698. doi:10.1093/cid/cix880.

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