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Streptococcus milleri and surgical sepsis
Abstract:
For many years Viridans streptococci have been considered as commensal organisms in a wide variety of sites in the human body and only regarded as significant pathogens in subacute bacterial endocarditis. However, in recent years some reports have suggested that a particular species, Streptococcus milleri, can be a virulent pathogen, producing life-threatening sepsis particularly in surgical patients. We review here our experience of this organism in 23 general surgical patients over a 3 year period, and postulate that prophylactic use of antibiotic combinations such as gentamicin and metronidazole in patients undergoing colo-rectal surgery may be a factor promoting its emergence as a significant pathogen. Patients with established sepsis due to Streptococcus milleri should be considered for long-term antibiotic therapy as part of the treatment of their abscesses.
Insights
Viridans streptococci, including Streptococcus milleri, are increasingly recognized as pathogens in surgical patients. Prophylactic antibiotics may contribute to their emergence, necessitating long-term therapy for associated abscesses.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Infections
Background:
- Viridans streptococci traditionally viewed as commensals, except in endocarditis.
- Emerging evidence suggests Streptococcus milleri as a significant pathogen, causing severe sepsis.
Purpose of the Study:
- To review the clinical experience with Streptococcus milleri in general surgical patients.
- To investigate potential factors contributing to the emergence of Streptococcus milleri as a pathogen.
Main Methods:
- Retrospective review of 23 general surgical patients over a 3-year period.
- Analysis of cases involving Streptococcus milleri infections.
Main Results:
- Streptococcus milleri identified as a cause of life-threatening sepsis in surgical patients.
- Postulation that prophylactic antibiotic combinations (e.g., gentamicin, metronidazole) in colorectal surgery may promote its emergence.
Conclusions:
- Streptococcus milleri is an emerging pathogen in surgical settings.
- Long-term antibiotic therapy is recommended for established sepsis and abscesses caused by Streptococcus milleri.
- Prophylactic antibiotic strategies in colorectal surgery warrant further investigation regarding their role in pathogen emergence.