Streptococcus bacteremia: Difference between revisions

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Streptococcus bacteremia
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!Number of BSIs
 
!Number of BSIs
 
|-
 
|-
 
|[[Group A Streptococcus]]
|
 
|[[Streptococcus pneumoniae]]
 
| style="color:darkgreen" |1.2%
 
| style="color:darkgreen" |2,598
 
|-
 
|
 
|[[Streptococcus dysgalactiae]]
 
| style="color:goldenrod" |6.6%
 
| style="color:goldenrod" |901
 
|-
 
|
 
 
|[[Streptococcus pyogenes]]
 
|[[Streptococcus pyogenes]]
 
| style="color:darkgreen" |1.9%
 
| style="color:darkgreen" |1.9%
 
| style="color:darkgreen" |592
 
| style="color:darkgreen" |592
 
|-
 
|-
 
|[[Group B Streptococcus]]
|
 
 
|[[Streptococcus agalactiae]]
 
|[[Streptococcus agalactiae]]
 
| style="color:goldenrod" |9.1%
 
| style="color:goldenrod" |9.1%
 
| style="color:goldenrod" |441
 
| style="color:goldenrod" |441
 
|-
 
|-
|[[VGS]], [[Streptococcus anginosus group]]
+
|[[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]]
 
|[[Streptococcus anginosus]]
 
| style="color:goldenrod" |4.8%
 
| style="color:goldenrod" |4.8%
 
| style="color:goldenrod" |437
 
| style="color:goldenrod" |437
 
|-
 
|-
|[[VGS]], [[Streptococcus mitis group]]
+
|[[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]]
 
|[[Streptococcus mitis]] or [[Streptococcus oralis|oralis]]
 
| style="color:darkred" |19.4%
 
| style="color:darkred" |19.4%
 
| style="color:darkred" |408
 
| style="color:darkred" |408
 
|-
 
|-
  +
|'''[[Streptococcus cristatus]] or [[Streptococcus sinensis|sinensis]]'''
|
 
 
| style="color:darkred" |'''44%'''
|'''[[Streptococcus gallolyticus]]'''
 
| style="color:darkred" |'''30.7%'''
+
| style="color:darkred" |'''9'''
| style="color:darkred" |'''225'''
 
 
|-
 
|-
|[[VGS]], [[Streptococcus salivarius group]]
+
|[[Streptococcus peroris]]
 
| style="color:darkgreen" |0
|[[Streptococcus salivarius]]
 
| style="color:goldenrod" |5.8%
+
| style="color:darkgreen" |10
 
|-
| style="color:goldenrod" |191
 
  +
| rowspan="3" |[[VGS]], [[Streptococcus sanguinis group]]
 
|'''[[Streptococcus gordonii]]'''
 
| style="color:darkred" |'''44.2%'''
 
| style="color:darkred" |'''95'''
 
|-
 
|-
|[[VGS]], [[Streptococcus sanguinis group]]
 
 
|'''[[Streptococcus sanguinis]]'''
 
|'''[[Streptococcus sanguinis]]'''
 
| style="color:darkred" |'''34.6%'''
 
| style="color:darkred" |'''34.6%'''
 
| style="color:darkred" |'''133'''
 
| style="color:darkred" |'''133'''
 
|-
 
|-
|[[VGS]], [[Streptococcus sanguinis group]]
 
 
|[[Streptococcus parasanguinis]]
 
|[[Streptococcus parasanguinis]]
 
| style="color:darkred" |10.3%
 
| style="color:darkred" |10.3%
 
| style="color:darkred" |107
 
| style="color:darkred" |107
 
|-
 
|-
|[[VGS]], [[Streptococcus sanguinis group]]
+
| rowspan="3" |[[VGS]], [[Streptococcus salivarius group]]
|'''[[Streptococcus gordonii]]'''
+
|[[Streptococcus salivarius]]
| style="color:darkred" |'''44.2%'''
+
| style="color:goldenrod" |5.8%
| style="color:darkred" |'''95'''
+
| style="color:goldenrod" |191
 
|-
 
|-
|[[VGS]], [[Streptococcus anginosus group]]
+
|[[Streptococcus vestibularis]]
 
| style="color:goldenrod" |low
|[[Streptococcus constellatus]]
 
 
| style="color:goldenrod" |26
 
|-
 
|[[Streptococcus thermophilus]]
 
| style="color:goldenrod" |<4%
 
| style="color:goldenrod" |<4%
| style="color:goldenrod" |91
+
| style="color:goldenrod" |45
 
|-
 
|-
|[[VGS]], [[Streptococcus mutans group]]
+
| rowspan="2" |[[VGS]], [[Streptococcus mutans group]]
 
|'''[[Streptococcus mutans]]'''
 
|'''[[Streptococcus mutans]]'''
 
| style="color:darkred" |'''47.9%'''
 
| style="color:darkred" |'''47.9%'''
 
| style="color:darkred" |'''48'''
 
| style="color:darkred" |'''48'''
 
|-
 
|-
|[[VGS]], [[Streptococcus salivarius group]]
+
|[[Streptococcus sobrinus]]
 
| style="color:darkgreen" |0
|[[Streptococcus thermophilus]]
 
| style="color:goldenrod" |<4%
+
| style="color:darkgreen" |<4
| style="color:goldenrod" |45
 
 
|-
 
|-
|[[Nutritionally variant streptococci]]
+
| rowspan="2" |[[Nutritionally variant streptococci]]
 
|[[Granulicatella adiacens]]
 
|[[Granulicatella adiacens]]
 
| style="color:darkred" |12.2%
 
| style="color:darkred" |12.2%
 
| style="color:darkred" |41
 
| style="color:darkred" |41
 
|-
 
|-
 
|[[Granulicatella elegans]]
|[[VGS]], [[Streptococcus anginosus group]]
 
 
| style="color:darkgreen" |0
|[[Streptococcus intermedius]]
 
| style="color:darkgreen" |0%
+
| style="color:darkgreen" |5
| style="color:darkgreen" |40
 
 
|-
 
|-
|[[VGS]], [[Streptococcus salivarius group]]
+
| rowspan="5" |[[Streptococcus bovis group]]
|[[Streptococcus vestibularis]]
+
|'''[[Streptococcus gallolyticus]]'''
| style="color:goldenrod" |low
+
| style="color:darkred" |'''30.7%'''
| style="color:goldenrod" |26
+
| style="color:darkred" |'''225'''
 
|-
 
|-
|
 
 
|[[Streptococcus lutetiensis]]
 
|[[Streptococcus lutetiensis]]
 
| style="color:goldenrod" |low
 
| style="color:goldenrod" |low
 
| style="color:goldenrod" |23
 
| style="color:goldenrod" |23
 
|-
 
|-
|
 
 
|[[Streptococcus infantarius]]
 
|[[Streptococcus infantarius]]
 
| style="color:darkred" |low
 
| style="color:darkred" |low
 
| style="color:darkred" |14
 
| style="color:darkred" |14
 
|-
 
|-
|
 
 
|[[Streptococcus equinus]]
 
|[[Streptococcus equinus]]
 
| style="color:darkred" |low
 
| style="color:darkred" |low
 
| style="color:darkred" |12
 
| style="color:darkred" |12
 
|-
 
|-
 
|[[Streptococcus alactolyticus]]
|
 
|[[Streptococcus peroris]]
 
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |0
| style="color:darkgreen" |10
+
| style="color:darkgreen" |<4
 
|-
 
|-
 
|
 
|
|'''[[Streptococcus cristatus]] or [[Streptococcus sinensis|sinensis]]'''
+
|[[Streptococcus pneumoniae]]
| style="color:darkred" |'''44%'''
+
| style="color:darkgreen" |1.2%
| style="color:darkred" |'''9'''
+
| style="color:darkgreen" |2,598
 
|-
 
|-
 
|
 
|
 
|[[Streptococcus massiliensis]]
 
|[[Streptococcus massiliensis]]
| style="color:darkgreen" |0
 
| style="color:darkgreen" |5
 
|-
 
|[[Nutritionally variant streptococci]]
 
|[[Granulicatella elegans]]
 
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |5
 
| style="color:darkgreen" |5
Line 137: Line 138:
 
|
 
|
 
|[[Streptococcus pluranimalium]]
 
|[[Streptococcus pluranimalium]]
| style="color:darkgreen" |0
 
| style="color:darkgreen" |<4
 
|-
 
|
 
|[[Streptococcus equi]]
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |<4
 
|-
 
|
 
|[[Streptococcus sobrinus]]
 
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |<4
 
| style="color:darkgreen" |<4
Line 152: Line 143:
 
|
 
|
 
|[[Streptococcus suis]]
 
|[[Streptococcus suis]]
| style="color:darkgreen" |0
 
| style="color:darkgreen" |<4
 
|-
 
|
 
|[[Streptococcus alactolyticus]]
 
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |0
 
| style="color:darkgreen" |<4
 
| style="color:darkgreen" |<4

Revision as of 08:52, 4 May 2023


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
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.