Bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus is associated with digestive tract malignancies and resistance to macrolides and clindamycin
Journal
Journal of Infection
Journal Volume
69
Journal Issue
2
Pages
145-153
Date Issued
2014
Abstract
Objectives: This study was intended to delineate the association between digestive tract malignancies and bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus. Methods: We reviewed the medical records and microbiological results of patients with bacteraemia due to Streptococcus bovis during the period 2000-2012. Species and subspecies identification of isolates originally classified as S. bovis was confirmed by 16S rRNA sequencing and PCR restriction fragment length polymorphism (PCR-RFLP) assays. Minimum inhibitory concentrations of antimicrobial agents were determined by the broth microdilution method. Results: Of the 172 S. bovis complex isolates obtained from 172 patients (age range, <1-94 years, median age, 66) with bacteraemia, 31 isolates were identified to be S. gallolyticus subspecies gallolyticus, 126 were S. gallolyticus subspecies pasteurianus, and 15 were shown to be Streptococcus infantarius. The majority (n=104, 60%) of patients were male and had underlying malignancies (n=87, 51%). Bacteraemia due to S. gallolyticus subspecies gallolyticus was significantly associated with endocarditis while S. gallolyticus subspecies pasteurianus was more likely to be associated with malignancies of the digestive tract, including gastric, pancreatic, hepatobiliary and colorectal cancers. Septic shock at presentation was the only factor associated with mortality among patients with bacteraemia due to either subspecies of S. bovis. Isolates of S. gallolyticus subspecies pasteurianus had higher rates of resistance to macrolides and clindamycin than isolates of S. gallolyticus subspecies gallolyticus. Conclusion: Extensive diagnostic work-up for digestive tract malignancies and trans-esophageal echocardiogram should be investigated in patients with bacteraemia caused by S. gallolyticus. ? 2014 The British Infection Association.
SDGs
Other Subjects
azithromycin; ceftriaxone; clindamycin; daptomycin; erythromycin; gentamicin; levofloxacin; linezolid; moxifloxacin; penicillin derivative; RNA 16S; tigecycline; vancomycin; antiinfective agent; clindamycin; macrolide; penicillin derivative; RNA 16S; adolescent; adult; aged; antibiotic resistance; antibiotic sensitivity; antimicrobial activity; article; bacteremia; bacterium identification; bacterium isolate; broth dilution; child; colorectal cancer; controlled study; disease association; endocarditis; female; gene sequence; hepatobiliary system tumor; human; major clinical study; male; minimum inhibitory concentration; mortality; multiple organ failure; pancreas cancer; polymerase chain reaction; restriction fragment length polymorphism; RNA sequence; septic shock; sequence analysis; skin infection; soft tissue infection; stomach cancer; Streptococcus; Streptococcus bovis; Streptococcus gallolyticus; Streptococcus infantarius; bacteremia; classification; complication; drug effects; gastrointestinal disease; gastrointestinal tract; genetics; infant; isolation and purification; microbial sensitivity test; microbiology; middle aged; multidrug resistance; multivariate analysis; pathology; preschool child; retrospective study; statistical model; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Clindamycin; Drug Resistance, Multiple, Bacterial; Female; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Infant; Logistic Models; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Penicillins; Polymorphism, Restriction Fragment Length; Retrospective Studies; RNA, Ribosomal, 16S; Streptococcus; Young Adult
Publisher
W.B. Saunders Ltd
Type
journal article