The clinical significance of Viridans streptococcal bacteraemia in patients at a district general hospital
Abstract number: 1734_74
Tan L., Lacey S., Melzer M.
Objectives: Viridans streptococci (VS) are low virulent commensals of the upper respiratory tract (URT). Community-acquired bacteraemia occurs commonly but its clinical significance in children and immunocompetent adults has not been well studied. Our aim was to determine the proportion of community-acquired bacteraemia caused by VS, their significance, sites of infection and 30-day mortality.
Methods: Patients with VS bacteraemia were identified from a database at a UK district general hospital from September 2003-October 2005. Available case notes were retrospectively reviewed for demographic and clinical data. Cultures were classified according to definite, probable or no clinical significance, depending on the number of positive blood cultures and compatible clinical syndrome. Patients with suspected infection were treated empirically based on likely site and local antibiotic policy. Following VS identification, antibiotics were altered according to site and sensitivities.
Results: VS caused 63/829 (7.6%) community-acquired bacteraemias, 50/723 (6.9%) in adults and 13/106 (12.3%) in children. 55 notes were available for review. There were no neutropenic patients. Among adults, four (9.3%) cultures were of definite clinical significance, 17 (39.5%) of probable significance and 22 (51.2%) not significant. There were four (9.3%) cases of infective endocarditis, one (2.3%) possible endocarditis, seven (16.3%) lower respiratory tract (LRT) infections and two (4.6%) female genital tract infections. Four (9.3%) patients had URT symptoms. Non-significant cultures included two (4.7%) patients with poor dentition, one (2.3%) post seizure, and 19 (44.2%) with no identifiable source. Among children, five (41.7%) cultures were of probable significance and seven (58.3%) were not significant. There were two (16.7%) LRT infections and three (25%) URT infections. Non-significant cultures included four (33.3%) bacteraemic episodes post seizure or febrile convulsion. Overall, one patient died as a consequence of infection (LRT). 20% of isolates were penicillin resistant, 25% erythromycin resistant and 4% amoxicillin resistant.
Conclusion: In adults, the lower respiratory tract is commonest site of infection but infective endocarditis also occurs. In children, the lower respiratory tract is the commonest site of infection and febrile convulsions are commonly associated with non-significant VS bacteraemia. Despite penicillin resistance, mortality was low and infections were easily treated.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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