Streptococcus bacteremia
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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%1
- This varies greatly by species, with the highest-risk species being Streptococcus gallolyticus, Streptococcus sanguinis, Streptococcus gordonii, and Streptococcus mutans
| Species | Risk of IE | Number of BSIs |
|---|---|---|
| Streptococcus pneumoniae | 1.2% | 2,598 |
| Streptococcus dysgalactiae | 6.6% | 901 |
| Streptococcus pyogenes | 1.9% | 592 |
| Streptococcus agalactiae | 9.1% | 441 |
| Streptococcus anginosus group | 4.8% | 437 |
| Streptococcus mitis or oralis | 19.4% | 408 |
| Streptococcus gallolyticus | 30.7% | 225 |
| Streptococcus salivarius | 5.8% | 191 |
| Streptococcus sanguinis | 34.6% | 133 |
| Streptococcus parasanguinis | 10.3% | 107 |
| Streptococcus gordonii | 44.2% | 95 |
| Streptococcus constellatus | <4% | 91 |
| Streptococcus mutans | 47.9% | 48 |
| Streptococcus thermophilus | <4% | 45 |
| Granulicatella adiacens | 12.2% | 41 |
| Streptococcus intermedius | 0% | 40 |
| Streptococcus vestibularis | low | 26 |
| Streptococcus lutetiensis | low | 23 |
| Streptococcus infantarius | low | 14 |
| Streptococcus equinus | low | 12 |
| Streptococcus peroris | 0 | 10 |
| Streptococcus cristatus or sinensis | 44% | 9 |
| Streptococcus massiliensis | 0 | 5 |
| Granulicatella elegans | 0 | 5 |
| Streptococcus pluranimalium | 0 | <4 |
| Streptococcus equi | 0 | <4 |
| Streptococcus sobrinus | 0 | <4 |
| Streptococcus suis | 0 | <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
- 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
- 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.
