Is Echocardiography Mandatory for All Streptococcus gallolyticus Subsp. pasteurianus Bacteremia?

Figures & data

Table 1 Baseline Characteristics of All S. gallolyticus Subsp. pasteurianus Bacteremic Participants

Characteristic	N	%
Male	65/106	61.3
Age (mean (SD), years)	66.9 (15.7)
Underlying disease	100/106	94.3
Cirrhosis	49/106	46.2
Diabetes	32/106	30.2
Chronic kidney disease/ESRD	26/106	18.7
Neurovascular disease	11/106	10.4
Hematologic disease	9/106	8.5
Biliary stone	6/106	5.7
Chronic liver disease	4/106	3.8
Autoimmune disease	4/106	3.8
Others	17/106	16
Malignancy diagnosed before presentation	20/106	18.8
Hepatocellular carcinoma	7/20	35
Colorectal cancer	6/20	30
Hematologic malignancy	2/20	10
Others	5/20	25
Clinical syndrome
Primary bacteremia	47/106	44.3
Spontaneous bacterial peritonitis	25/106	23.6
Endocarditis	9/106	8.5
Intraabdominal infection	4/106	3.8
Biliary tract infection	4/106	3.8
Skin and soft tissue infection	4/106	3.8
CNS infection	4/106	3.8
Other clinical syndromes	9/106	8.5
Complications
Acute kidney injury	43/106	40.6
Septic shock	40/106	37.7
Respiratory failure	11/106	10.4
Multiorgan failure	9/106	8.5
DIC	7/106	6.6
Number of positive specimens
≥2 specimens	81/106	76.4
Echocardiography performed	35/106	33
Colonoscopy performed	11/106	10.4
30-day mortality rate	23/106	21.7
Length of hospital stay (median (IQR), days)	12 (6–22)

Figure 1 Patients underwent echocardiography.

Table 2 Characteristics of Nine Patients with Endocarditis

Case	Age(Yrs.)/Sex	Underlying Disease	Modified Duke’s Criteria Major/Minor Criteria	Valve	Treatment	Outcome
1	71/male	Diabetes	2/1	Aortic	Ceftriaxone	Cure
2	43/male	ESRD*Lymphoma	2/1	Mitral	PGS*	Death
3	72/male	Cerebrovascular disease	2/2	Mitral	PGS*	Cure
4	80/male	Hypertension	2/2	Aortic	Ceftriaxone	Cure
5	78/male	Dyslipidemia	2/2	Aortic	Ceftriaxone	Cure
6	44/male	None	2/2	Aortic	PGS*	Death
7	84/male	DiabetesColonic cancer	2/2	Mitral	PGS*	Cure
8	70/female	Hypertension	2/3	Aortic	PGS*	Death
9	51/female	ESRD*	1/3	Aortic	Ceftriaxone	Death

Abbreviations: *PGS, penicillin G sodium; ESRD, End stage renal disease.

Table 3 Univariate Analysis of Factors Associated with Infective Endocarditis in S. gallolyticus Subsp. pasteurianus Bacteremia

Factor	IE n (%)	Control n (%)	Odds Ratio (95% CI)	p-value
Male	7 (77.78)	58 (59.8)	2.35 (0.46–11.93)	0.477
Age >65 yrs.	6 (66.67)	52 (53.61)	1.73 (0.41–7.32)	0.507
With underlying disease	8 (88.89)	92 (94.85)	0.44 (0.05–4.19)	0.421
Diabetes	2 (22.23)	30 (30.93)	0.64 (0.13–3.26)	0.720
Chronic liver disease	1 (11.12)	3 (3.1)	3.92 (0.36–42.13)	0.300
Cirrhosis	0 (0)	49 (50.52)	0	0.003
Chronic kidney disease	0 (0)	18 (18.56)	0	0.350
End-stage renal disease	2 (22.23)	6 (6.19)	4.33 (0.73–25.58)	0.137
Neurovascular disease	1 (11.12)	10 (10.31)	1.09 (0.12–9.62)	1
Hematologic disease	1 (11.12)	8 (8.25)	1.39 (0.15–12.57)	0.560
Malignancy	1 (11.12)	20 (20.62)	0.48 (0.06–4.08)	0.680
Complication
Septic shock	1 (11.12)	39 (40.21)	0.19 (0.02–1.55)	0.150
Acute kidney injury	0 (0)	43 (44.33)	0	0.010
Respiratory failure	3 (33.34)	8 (8.25)	5.56 (1.17–26.56)	0.050
Multiorgan failure	2 (22.23)	7 (7.22)	3.67 (0.64–21.13)	0.170
DIC	1 (11.12)	6 (6.19)	1.9 (0.2–17.76)	0.473
Blood culture positive ≥2 specimens	8 (88.89)	72 (74.23)	2.78 (0.33–23.33)	0.079

Table 4 Susceptibility Data of 106 Isolates of S. gallolyticus Subsp. pasteurianus

Antimicrobial Agent	Disk Diffusion Test						Epsilometer test (E-test)
	Susceptible		Intermediate		Resistance		MIC Range (ug/mL)	MIC50 (ug/mL)	MIC90 (ug/mL)
	No.	%	No.	%	No.	%
Penicillin	103	97.2	3	2.8	0	0	0.06–0.25	0.09	0.19
Ceftriaxone	97	91.5	2	1.9	7	6.6	0.09–0.75	0.19	0.5
Levofloxacin	89	84.0	6	5.7	11	10.4	N/A	N/A	N/A
Chloramphenicol	101	95.3	2	1.9	3	2.8	N/A	N/A	N/A
Erythromycin	26	24.5	0	0	80	75.5	N/A	N/A	N/A
Vancomycin	106	100.0	0	0	0	0	N/A	N/A	N/A
Linezolid	106	100.0	0	0	0	0	N/A	N/A	N/A