TAILIEUCHUNG - Chapter 130. Streptococcal and Enterococcal Infections (Part 13)

Infection with Viridans Streptococci: Treatment Isolates from neutropenic patients with bacteremia are often resistant to penicillin; thus these patients should be treated presumptively with vancomycin until the results of susceptibility testing become available. Viridans streptococci isolated in other clinical settings usually are sensitive to penicillin. Abiotrophia Species (Nutritionally Variant Streptococci) Occasional isolates cultured from the blood of patients with endocarditis fail to grow when subcultured on solid media. These nutritionally variant streptococci require supplemental thiol compounds or active forms of vitamin B 6 (pyridoxal or pyridoxamine) for growth in the laboratory. The nutritionally variant streptococci are generally grouped with the viridans streptococci. | Chapter 130. Streptococcal and Enterococcal Infections Part 13 Infection with Viridans Streptococci Treatment Isolates from neutropenic patients with bacteremia are often resistant to penicillin thus these patients should be treated presumptively with vancomycin until the results of susceptibility testing become available. Viridans streptococci isolated in other clinical settings usually are sensitive to penicillin. Abiotrophia Species Nutritionally Variant Streptococci Occasional isolates cultured from the blood of patients with endocarditis fail to grow when subcultured on solid media. These nutritionally variant streptococci require supplemental thiol compounds or active forms of vitamin B6 pyridoxal or pyridoxamine for growth in the laboratory. The nutritionally variant streptococci are generally grouped with the viridans streptococci because they cause similar types of infections. However they have been reclassified on the basis of 16S ribosomal RNA sequence comparisons into a separate genus Abiotrophia with two species A. defectivus and A. adjacens. Infection with Nutritionally Variant Streptococci Treatment Treatment failure and relapse appear to be more common in cases of endocarditis due to nutritionally variant streptococci than in those due to the usual viridans streptococci. Thus the addition of gentamicin 1 mg kg every 8 h for patients with normal renal function to the penicillin regimen is recommended for endocarditis due to the nutritionally variant organisms. Other Streptococci S. suis is an important pathogen in swine and has been reported to cause meningitis in humans usually in individuals with occupational exposure to pigs. Strains of S. suis associated with human infections have generally reacted with Lancefield group R typing serum and sometimes with group D typing serum as well. Isolates may be a- or 0-hemolytic and are sensitive to penicillin. S. iniae a pathogen of fish has been associated with infections in humans who have handled live or

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