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Clinically significant Streptococcus anginosus (Streptococcus milleri) infections: a review of 186 cases
Abstract:
We describe clinically significant infections due to Streptococcus anginosus in 186 patients; 114 (61.3%) males and 72 (38.7%) females, median age 42 years, range 9 months to 93 years. In 101 (54.3%) cases S anginosus alone caused infection and in 85 (45.7%) cases it was associated with other microorganisms. Abscesses accounted for 110 (59.1%) infections. Sites of infection were: miscellaneous skin and soft tissue, 64 (34.4%), intraabdominal 41 (22%), head and neck 34 (18.3%), pleuropulmonary 22 (11.8%), genitourinary 9 (4.8%), musculoskeletal 6 (3.2%), endocarditis 5 (2.7%) and primary bacteraemia 5 (2.7%). Treatment consisted of antibiotic therapy which was often prolonged, median 30 days, range 2-90 days, and surgery in 159 (85.5%). S anginosus infection was a contributory factor in two of the three deaths which occurred.
Insights
Streptococcus anginosus infections commonly cause abscesses, often requiring prolonged antibiotic therapy and surgery. This study details 186 cases, highlighting common sites and outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Bacteriology
Background:
- Streptococcus anginosus group (SAG) bacteria are increasingly recognized as significant human pathogens.
- SAG infections can manifest in diverse clinical settings, often presenting as abscesses.
- Understanding the epidemiology and clinical spectrum of SAG infections is crucial for effective management.
Purpose of the Study:
- To characterize the clinical significance of infections caused by Streptococcus anginosus.
- To identify common sites, associated microorganisms, and treatment outcomes for S. anginosus infections.
- To evaluate the role of S. anginosus in patient mortality.
Main Methods:
- Retrospective analysis of 186 patients with clinically significant infections due to Streptococcus anginosus.
- Data collection included patient demographics, infection sites, microbiological findings, treatment modalities, and outcomes.
- Statistical analysis was performed to determine the frequency of various clinical presentations and outcomes.
Main Results:
- A total of 186 patients were included, with a median age of 42 years.
- Abscesses were the most common presentation, accounting for 59.1% of infections.
- Skin and soft tissue (34.4%) and intra-abdominal (22%) sites were frequently involved; S. anginosus was associated with other microorganisms in 45.7% of cases.
- Treatment involved prolonged antibiotic therapy (median 30 days) and surgery (85.5%).
- S. anginosus contributed to two of the three reported deaths.
Conclusions:
- Streptococcus anginosus is a significant cause of diverse infections, particularly abscesses.
- Management often requires a combination of prolonged antibiotics and surgical intervention.
- While mortality is low, S. anginosus can be a contributing factor in severe cases.