Streptococcus bacteremia: Difference between revisions

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

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


* Consider using the [[HANDOC score]] to risk stratify for need for [[echocardiography]]
* 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]]
[[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. a b  Sandra Chamat-Hedemand, Anders Dahl, Lauge Østergaard, Magnus Arpi, Emil Fosbøl, Jonas Boel, Louise Bruun Oestergaard, Trine K. Lauridsen, Gunnar Gislason, Christian Torp-Pedersen, Niels Eske Bruun. Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species. Circulation. 2020;142(8):720-730. doi:10.1161/circulationaha.120.046723.

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