Streptococcus bacteremia: Difference between revisions
From IDWiki
Streptococcus bacteremia
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{| class="wikitable sortable mw-collapsible" |
{| class="wikitable sortable mw-collapsible" |
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+ | !Group |
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!Species |
!Species |
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!Risk of IE |
!Risk of IE |
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!Number of BSIs |
!Number of BSIs |
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|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus pneumoniae]] |
|
| style="color:darkgreen" |1.2% |
| style="color:darkgreen" |1.2% |
||
| style="color:darkgreen" |2,598 |
| style="color:darkgreen" |2,598 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus dysgalactiae]] |
|
| style="color:goldenrod" |6.6% |
| style="color:goldenrod" |6.6% |
||
| style="color:goldenrod" |901 |
| style="color:goldenrod" |901 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus pyogenes]] |
|
| style="color:darkgreen" |1.9% |
| style="color:darkgreen" |1.9% |
||
| style="color:darkgreen" |592 |
| style="color:darkgreen" |592 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus agalactiae]] |
|
| style="color:goldenrod" |9.1% |
| style="color:goldenrod" |9.1% |
||
| style="color:goldenrod" |441 |
| style="color:goldenrod" |441 |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus anginosus group]] |
+ | |[[Streptococcus anginosus]] |
||
| style="color:goldenrod" |4.8% |
| style="color:goldenrod" |4.8% |
||
| style="color:goldenrod" |437 |
| style="color:goldenrod" |437 |
||
|- |
|- |
||
− | + | |[[VGS]], [[Streptococcus mitis group]] |
|
⚫ | |||
| style="color:darkred" |19.4% |
| style="color:darkred" |19.4% |
||
| style="color:darkred" |408 |
| style="color:darkred" |408 |
||
|- |
|- |
||
+ | | |
||
− | + | |'''[[Streptococcus gallolyticus]]''' |
|
| style="color:darkred" |'''30.7%''' |
| style="color:darkred" |'''30.7%''' |
||
| style="color:darkred" |'''225''' |
| style="color:darkred" |'''225''' |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus salivarius group]] |
+ | |[[Streptococcus salivarius]] |
||
| style="color:goldenrod" |5.8% |
| style="color:goldenrod" |5.8% |
||
| style="color:goldenrod" |191 |
| style="color:goldenrod" |191 |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus sanguinis group]] |
+ | |'''[[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]] |
||
| style="color:darkred" |10.3% |
| style="color:darkred" |10.3% |
||
| style="color:darkred" |107 |
| style="color:darkred" |107 |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus sanguinis group]] |
+ | |'''[[Streptococcus gordonii]]''' |
||
| style="color:darkred" |'''44.2%''' |
| style="color:darkred" |'''44.2%''' |
||
| style="color:darkred" |'''95''' |
| style="color:darkred" |'''95''' |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus anginosus group]] |
+ | |[[Streptococcus constellatus]] |
||
| style="color:goldenrod" |<4% |
| style="color:goldenrod" |<4% |
||
| style="color:goldenrod" |91 |
| style="color:goldenrod" |91 |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus mutans group]] |
+ | |'''[[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 thermophilus]] |
||
| style="color:goldenrod" |<4% |
| style="color:goldenrod" |<4% |
||
| style="color:goldenrod" |45 |
| style="color:goldenrod" |45 |
||
|- |
|- |
||
+ | |[[Nutritionally variant streptococci]] |
||
− | + | |[[Granulicatella adiacens]] |
|
| style="color:darkred" |12.2% |
| style="color:darkred" |12.2% |
||
| style="color:darkred" |41 |
| style="color:darkred" |41 |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus anginosus group]] |
+ | |[[Streptococcus intermedius]] |
||
| style="color:darkgreen" |0% |
| style="color:darkgreen" |0% |
||
| style="color:darkgreen" |40 |
| style="color:darkgreen" |40 |
||
|- |
|- |
||
− | | |
+ | |[[VGS]], [[Streptococcus salivarius group]] |
+ | |[[Streptococcus vestibularis]] |
||
| style="color:goldenrod" |low |
| style="color:goldenrod" |low |
||
| style="color:goldenrod" |26 |
| style="color:goldenrod" |26 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus lutetiensis]] |
|
| style="color:goldenrod" |low |
| style="color:goldenrod" |low |
||
| style="color:goldenrod" |23 |
| style="color:goldenrod" |23 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus infantarius]] |
|
| style="color:darkred" |low |
| style="color:darkred" |low |
||
| style="color:darkred" |14 |
| style="color:darkred" |14 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus equinus]] |
|
| style="color:darkred" |low |
| style="color:darkred" |low |
||
| style="color:darkred" |12 |
| style="color:darkred" |12 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus peroris]] |
|
| style="color:darkgreen" |0 |
| style="color:darkgreen" |0 |
||
| style="color:darkgreen" |10 |
| style="color:darkgreen" |10 |
||
|- |
|- |
||
+ | | |
||
⚫ | |||
+ | |'''[[Streptococcus cristatus]] or [[Streptococcus sinensis|sinensis]]''' |
||
| style="color:darkred" |'''44%''' |
| style="color:darkred" |'''44%''' |
||
| style="color:darkred" |'''9''' |
| style="color:darkred" |'''9''' |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus massiliensis]] |
|
| style="color:darkgreen" |0 |
| style="color:darkgreen" |0 |
||
| style="color:darkgreen" |5 |
| 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 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus pluranimalium]] |
|
| style="color:darkgreen" |0 |
| style="color:darkgreen" |0 |
||
| style="color:darkgreen" |<4 |
| style="color:darkgreen" |<4 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus equi]] |
|
| style="color:darkgreen" |0 |
| style="color:darkgreen" |0 |
||
| style="color:darkgreen" |<4 |
| style="color:darkgreen" |<4 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus sobrinus]] |
|
| style="color:darkgreen" |0 |
| style="color:darkgreen" |0 |
||
| style="color:darkgreen" |<4 |
| style="color:darkgreen" |<4 |
||
|- |
|- |
||
+ | | |
||
− | + | |[[Streptococcus suis]] |
|
| style="color:darkgreen" |0 |
| style="color:darkgreen" |0 |
||
| style="color:darkgreen" |<4 |
| 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 09:31, 4 May 2023
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 and three Viridans group streptococci, Streptococcus sanguinis, Streptococcus gordonii, and Streptococcus mutans
- 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.