Bacteremic Streptococcus bovis infections at a University Hospital, 1992-2001

Shio Shin Jean, Lee Jene Teng, Po Ren Hsueh, Shen Wu Ho, Kwen Tay Luh

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background and Purpose: The association of Streptococcus bovis biotypes with types of clinical infection and underlying malignancies has rarely been reported in Taiwan. The aim of this study was to characterize the clinical features and microbiological characteristics of patients with S. bovis bacteremia. Methods: From January 1992 to December 2001, 62 patients with S. bovis bacteremia were treated at National Taiwan University Hospital. Their demographic characteristics, clinical features, results of imaging studies, pathological findings, and laboratory data were retrospectively analyzed. Antimicrobial susceptibilities were determined using the agar dilution method and biotypes were determined using the API 20 Strep system. Results: The majority of cases (76%) occurred during the 1996-1997 and 1999-2000 periods. Thirty five patients were male, and the mean age of the 62 patients was 61 years. Underlying diseases included malignancies (40%), cardiac diseases (27%), diabetes mellitus (24%), and liver cirhosis (21%). Fifty two percent (n=32) of patients presented with primary bacteremia and 24% (15) with definite or possible infective endocarditis. Thirteen percent (8) presented with hepatobiliary infections (acute cholecystitis and biliary tract infection). Ten patients (16%) had polymicrobial bacteremia. All of the concomitant pathogen(s) were Gram-negative rods, among with Escherichia coli predominated. The mortality rate on day 30 of illness was 21%. High Acute Physiology and Chronic Health Evaluation (APACHE) II score on the day of positive blood culture was associated with high mortality. Among the 19 patients (31%) who underwent colonoscopy, 9 (47%) had colonic lesions (tubular adenomas or carcinomas). Of the 26 patients (41%) who underwent echocardiography, 14 (54%) had vegetation in the valves. Of the 47 S. bovis isolates examined for biotypes, 37 (79%) were biotype II (29 of biotype II/2 and 8 of biotypes II/1) nad 10 (21%) were biotype I. The majority of isolates causing primary bacteremia (92%), hepatobiliary infections (100%) and primary bacterial peritonitis (100%) were biotype II, while 67% of isolates associated with infective endocarditis were biotype I. All isolates were susceptible to penicillin. Conclusions: Infective endocarditis should be highly suspected in patients with bacteremia due to S. bovis biotype I. Investigations for intra-abdominal foci other than the colon should be undertaken in patients with bacteremia caused by S. bovis biotype II. Due to the increasing number of S. bovis bacteremia patients of the hospital and unknown origins of about 50% of bacteremia cases, the need for colonoscopy and echocardiography in each case and biotyping of each blood isolate should be emphasized.

Original languageEnglish
Pages (from-to)118-123
Number of pages6
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume103
Issue number2
Publication statusPublished - Feb 2004
Externally publishedYes

Fingerprint

Streptococcus bovis
Bacteremia
Infection
Endocarditis
Colonoscopy
Taiwan
Echocardiography
Sick Leave
Acute Cholecystitis
APACHE
Mortality
Biliary Tract
Peritonitis
Penicillins
Adenoma
Agar
Heart Diseases
Neoplasms
Diabetes Mellitus
Colon

Keywords

  • APACHE II score
  • Colonoscopy
  • Colorectal neoplasms
  • Echocardiography
  • Streptococcus bovis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bacteremic Streptococcus bovis infections at a University Hospital, 1992-2001. / Jean, Shio Shin; Teng, Lee Jene; Hsueh, Po Ren; Ho, Shen Wu; Luh, Kwen Tay.

In: Journal of the Formosan Medical Association = Taiwan yi zhi, Vol. 103, No. 2, 02.2004, p. 118-123.

Research output: Contribution to journalArticle

Jean, Shio Shin ; Teng, Lee Jene ; Hsueh, Po Ren ; Ho, Shen Wu ; Luh, Kwen Tay. / Bacteremic Streptococcus bovis infections at a University Hospital, 1992-2001. In: Journal of the Formosan Medical Association = Taiwan yi zhi. 2004 ; Vol. 103, No. 2. pp. 118-123.
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abstract = "Background and Purpose: The association of Streptococcus bovis biotypes with types of clinical infection and underlying malignancies has rarely been reported in Taiwan. The aim of this study was to characterize the clinical features and microbiological characteristics of patients with S. bovis bacteremia. Methods: From January 1992 to December 2001, 62 patients with S. bovis bacteremia were treated at National Taiwan University Hospital. Their demographic characteristics, clinical features, results of imaging studies, pathological findings, and laboratory data were retrospectively analyzed. Antimicrobial susceptibilities were determined using the agar dilution method and biotypes were determined using the API 20 Strep system. Results: The majority of cases (76{\%}) occurred during the 1996-1997 and 1999-2000 periods. Thirty five patients were male, and the mean age of the 62 patients was 61 years. Underlying diseases included malignancies (40{\%}), cardiac diseases (27{\%}), diabetes mellitus (24{\%}), and liver cirhosis (21{\%}). Fifty two percent (n=32) of patients presented with primary bacteremia and 24{\%} (15) with definite or possible infective endocarditis. Thirteen percent (8) presented with hepatobiliary infections (acute cholecystitis and biliary tract infection). Ten patients (16{\%}) had polymicrobial bacteremia. All of the concomitant pathogen(s) were Gram-negative rods, among with Escherichia coli predominated. The mortality rate on day 30 of illness was 21{\%}. High Acute Physiology and Chronic Health Evaluation (APACHE) II score on the day of positive blood culture was associated with high mortality. Among the 19 patients (31{\%}) who underwent colonoscopy, 9 (47{\%}) had colonic lesions (tubular adenomas or carcinomas). Of the 26 patients (41{\%}) who underwent echocardiography, 14 (54{\%}) had vegetation in the valves. Of the 47 S. bovis isolates examined for biotypes, 37 (79{\%}) were biotype II (29 of biotype II/2 and 8 of biotypes II/1) nad 10 (21{\%}) were biotype I. The majority of isolates causing primary bacteremia (92{\%}), hepatobiliary infections (100{\%}) and primary bacterial peritonitis (100{\%}) were biotype II, while 67{\%} of isolates associated with infective endocarditis were biotype I. All isolates were susceptible to penicillin. Conclusions: Infective endocarditis should be highly suspected in patients with bacteremia due to S. bovis biotype I. Investigations for intra-abdominal foci other than the colon should be undertaken in patients with bacteremia caused by S. bovis biotype II. Due to the increasing number of S. bovis bacteremia patients of the hospital and unknown origins of about 50{\%} of bacteremia cases, the need for colonoscopy and echocardiography in each case and biotyping of each blood isolate should be emphasized.",
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T1 - Bacteremic Streptococcus bovis infections at a University Hospital, 1992-2001

AU - Jean, Shio Shin

AU - Teng, Lee Jene

AU - Hsueh, Po Ren

AU - Ho, Shen Wu

AU - Luh, Kwen Tay

PY - 2004/2

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N2 - Background and Purpose: The association of Streptococcus bovis biotypes with types of clinical infection and underlying malignancies has rarely been reported in Taiwan. The aim of this study was to characterize the clinical features and microbiological characteristics of patients with S. bovis bacteremia. Methods: From January 1992 to December 2001, 62 patients with S. bovis bacteremia were treated at National Taiwan University Hospital. Their demographic characteristics, clinical features, results of imaging studies, pathological findings, and laboratory data were retrospectively analyzed. Antimicrobial susceptibilities were determined using the agar dilution method and biotypes were determined using the API 20 Strep system. Results: The majority of cases (76%) occurred during the 1996-1997 and 1999-2000 periods. Thirty five patients were male, and the mean age of the 62 patients was 61 years. Underlying diseases included malignancies (40%), cardiac diseases (27%), diabetes mellitus (24%), and liver cirhosis (21%). Fifty two percent (n=32) of patients presented with primary bacteremia and 24% (15) with definite or possible infective endocarditis. Thirteen percent (8) presented with hepatobiliary infections (acute cholecystitis and biliary tract infection). Ten patients (16%) had polymicrobial bacteremia. All of the concomitant pathogen(s) were Gram-negative rods, among with Escherichia coli predominated. The mortality rate on day 30 of illness was 21%. High Acute Physiology and Chronic Health Evaluation (APACHE) II score on the day of positive blood culture was associated with high mortality. Among the 19 patients (31%) who underwent colonoscopy, 9 (47%) had colonic lesions (tubular adenomas or carcinomas). Of the 26 patients (41%) who underwent echocardiography, 14 (54%) had vegetation in the valves. Of the 47 S. bovis isolates examined for biotypes, 37 (79%) were biotype II (29 of biotype II/2 and 8 of biotypes II/1) nad 10 (21%) were biotype I. The majority of isolates causing primary bacteremia (92%), hepatobiliary infections (100%) and primary bacterial peritonitis (100%) were biotype II, while 67% of isolates associated with infective endocarditis were biotype I. All isolates were susceptible to penicillin. Conclusions: Infective endocarditis should be highly suspected in patients with bacteremia due to S. bovis biotype I. Investigations for intra-abdominal foci other than the colon should be undertaken in patients with bacteremia caused by S. bovis biotype II. Due to the increasing number of S. bovis bacteremia patients of the hospital and unknown origins of about 50% of bacteremia cases, the need for colonoscopy and echocardiography in each case and biotyping of each blood isolate should be emphasized.

AB - Background and Purpose: The association of Streptococcus bovis biotypes with types of clinical infection and underlying malignancies has rarely been reported in Taiwan. The aim of this study was to characterize the clinical features and microbiological characteristics of patients with S. bovis bacteremia. Methods: From January 1992 to December 2001, 62 patients with S. bovis bacteremia were treated at National Taiwan University Hospital. Their demographic characteristics, clinical features, results of imaging studies, pathological findings, and laboratory data were retrospectively analyzed. Antimicrobial susceptibilities were determined using the agar dilution method and biotypes were determined using the API 20 Strep system. Results: The majority of cases (76%) occurred during the 1996-1997 and 1999-2000 periods. Thirty five patients were male, and the mean age of the 62 patients was 61 years. Underlying diseases included malignancies (40%), cardiac diseases (27%), diabetes mellitus (24%), and liver cirhosis (21%). Fifty two percent (n=32) of patients presented with primary bacteremia and 24% (15) with definite or possible infective endocarditis. Thirteen percent (8) presented with hepatobiliary infections (acute cholecystitis and biliary tract infection). Ten patients (16%) had polymicrobial bacteremia. All of the concomitant pathogen(s) were Gram-negative rods, among with Escherichia coli predominated. The mortality rate on day 30 of illness was 21%. High Acute Physiology and Chronic Health Evaluation (APACHE) II score on the day of positive blood culture was associated with high mortality. Among the 19 patients (31%) who underwent colonoscopy, 9 (47%) had colonic lesions (tubular adenomas or carcinomas). Of the 26 patients (41%) who underwent echocardiography, 14 (54%) had vegetation in the valves. Of the 47 S. bovis isolates examined for biotypes, 37 (79%) were biotype II (29 of biotype II/2 and 8 of biotypes II/1) nad 10 (21%) were biotype I. The majority of isolates causing primary bacteremia (92%), hepatobiliary infections (100%) and primary bacterial peritonitis (100%) were biotype II, while 67% of isolates associated with infective endocarditis were biotype I. All isolates were susceptible to penicillin. Conclusions: Infective endocarditis should be highly suspected in patients with bacteremia due to S. bovis biotype I. Investigations for intra-abdominal foci other than the colon should be undertaken in patients with bacteremia caused by S. bovis biotype II. Due to the increasing number of S. bovis bacteremia patients of the hospital and unknown origins of about 50% of bacteremia cases, the need for colonoscopy and echocardiography in each case and biotyping of each blood isolate should be emphasized.

KW - APACHE II score

KW - Colonoscopy

KW - Colorectal neoplasms

KW - Echocardiography

KW - Streptococcus bovis

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