190. Clinical Presentation of Streptococcus gallolyticus Infections

Abstract

BackgroundThere are multiple publications on the association of Streptococcus gallolyticus (SG) with malignancies of the colon. SG has been also found in association with hepatocellular carcinoma, biliary tract infections, meningitis, endocarditis, urinary and other infections. In a preliminary analysis of SG and other streptococcal infections, we find that any of the GI flora may gain access to the bloodstream when there is a breach of the mucosa due to inflammation or malignant invasion. In our study, the majority of SG infections were polymicrobial and lower urinary tract infections were the most common presentation. Only 2 out of 45 had gastrointestinal malignancies both with polymicrobial blood culture results.MethodsWe evaluated 45 cases of SG seen in our health network hospitals for the past 15 months. The charts of all SG isolates were reviewed for age, sex, clinical presentation, laboratory data and susceptibilities.ResultsThere were 34 female and 11 male patients.The majority were elderly with only 5 patients below age 50, Thirty patients presented with urinary infections, 28 lower and 2 upper tract. All except 4 urinary infections were in females. Sixteen urinary infections were polymicrobial and 14 monomicrobial. Two upper tract urinary infections were monomicrobial.There were 8 bloodstream infections, 4 polymicrobial and 4 monomicrobial. Three gall bladder infections were polymicrobial and one monomicrobial. Two liver abscesses yielded polymicrobial flora. Only 4 patients had cancer 1. Metastatic pancreatic cancer 2. Carcinoma of the ampulla of Vater 3. Advanced prostate cancer 4. Anal cancer. Only 1 and 2 had positive blood cultures, both polymicrobial.The other 2 had polymicrobial lower tract urinary infections. One patient had aortic prosthetic valve endocarditis. All SG isolates tested were susceptible to penicillin, ceftriaxone and vancomycin.ConclusionThe most common presentation was urinary. There was a higher number of females due to a large number of urinary infections.The majority of infections were polymicrobial including all 4 cancer patients. Two bacteremias were associated with gastrointestinal malignancies but none with the colon. SG isolates were susceptible to penicillin, ceftriaxone and vancomycin.Disclosures All authors: No reported disclosures.