PTH-015 Specialist gastroenterology involvement inStreptococcus bovispositive cultures

Abstract

IntroductionThere is well documented evidence linking Streptococcus bovis (S bovis) bacteraemia to colonic neoplasms and polyps. As patients with S bovis bacteraemia can be found across various specialities, our aim was to audit the consistency of appropriate specialist referral for assessment of colonic pathology.MethodsAll cases of S bovis bacteraemia occurring between October 2000 and June 2009 were identified using information provided by the department of microbiology. Medical records were reviewed for clinical details, evidence of features of endocarditis and referral to gastroenterologists. The standard of best practice was all cases should be referred for appropriate specialist review.ResultsThere were 20 cases of S bovis bacteraemia from the total of 3454 positive cultures (0.6%). There were 11 male and 9 female and all were Caucasian with a mean age of 80.7 years. Four (20%) had endocarditis and four had abnormal liver enzymes. Seventeen patients had a microbiology report in the notes and 13 had Microbiologist advice to consider cardiac and/or colonic pathology. The gastroenterology team's opinion was sought for 10 (50%) patients and 10 patients underwent one or more investigations including gastroscopy, colonoscopy, flexible sigmoidoscopy and CT of the abdomen.60% of these investigations were performed on gastroenterology team's advice and the rest were done on the admitting team's initiative. In seven patients (35%) their prognosis at the time the bacteraemia was judged to be so poor as to preclude further investigation.Of the 10 patients who were investigated, six (60%) had positive findings. Two patients had colorectal adenocarcinoma (one rectum and one sigmoid); one had a stricture diagnosed on CT abdomen; and three had significant polyps (one or more tubulovillous adenomas with low grade dysplasia >1 cm). 60% of the patients in the study (12) were already deceased at the time of the audit and one patient had had a repeat colonoscopy after 1 year and had further polyps removed.ConclusionA lack of uniformity was observed in proper referral for gastroenterologist assessment and investigation. The age and multiple comorbidities of these patients made further investigations clinically inappropriate in 35% in this study. In the absence of proper guidelines regarding investigation of patients with S bovis bacteraemia for bowel pathology, we recommend seeking formal gastroenterology advice in all such patients. At the Royal Bournemouth Hospital, the department of microbiology has decided to inform the gastroenterology team of all S bovis positive cultures. Following these measures, this audit will be repeated.

Referral for Colonoscopy in Patients With Streptococcus bovis Bacteremia and the Association With Colorectal Cancer and Adenomatous Polyps: A Quality Assurance Study

“…The percentage of patients undergoing colonoscopy varies widely in reports from other centers (38-100%) [9,[11][12][13][14][15][16]; however it is not always clear whether they excluded patients who died during the index hospitalization, were made palliative, or had known CRC. One study auditing the consistency of specialist referral found that 10/13 (77%) cases were referred to gastroenterology after excluding seven patients judged to have a prognosis so poor as to preclude further investigations [17]. We found that a similar percentage of patients were referred for colonoscopy in our study.…”