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Streptococcal species as a prognostic factor for mortality in patients with streptococcal bloodstream infections

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Abstract

Purpose

Streptococcal bloodstream infections (BSIs) are common, yet prognostic factors are poorly investigated. We aimed to investigate the mortality according to streptococcal species and seasonal variation.

Methods

Patients with streptococcal BSIs from 2008 to 2017 in the Capital Region of Denmark were investigated, and data were crosslinked with nationwide registers for the identification of comorbidities. A multivariable logistic regression analysis was performed to assess mortality according to streptococcal species and season of infection.

Results

Among 6095 patients with a streptococcal BSI (mean age 68.1 years), the 30-day mortality was 16.1% and the one-year mortality was 31.5%. With S. pneumoniae as a reference, S. vestibularis was associated with a higher adjusted mortality both within 30 days (odds ratio (OR) 2.89 [95% confidence interval (CI) 1.20–6.95]) and one year (OR 4.09 [95% CI 1.70–9.48]). One-year mortality was also higher in S. thermophilus, S. constellatus, S. parasanguinis, S. salivarius, S. anginosus, and S. mitis/oralis. However, S. mutans was associated with a lower one-year mortality OR 0.44 [95% CI 0.20–0.97], while S. gallolyticus was associated with both a lower 30-day (OR 0.42 [95% CI 0.26–0.67]) and one-year mortality (OR 0.66 [95% CI 0.48–0.93]). Furthermore, with infection in the summer as a reference, patients infected in the winter and autumn had a higher association with 30-day mortality.

Conclusions

The mortality in patients with streptococcal BSI was associated with streptococcal species. Further, patients with streptococcal BSIs infected in the autumn and winter had a higher risk of death within 30 days, compared with patients infected in the summer.

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Data availability

All supportive data are available within the article and its supplementary files.

Abbreviations

ATC:

Anatomical therapeutic chemical

BC:

Blood culture

BSI:

Bloodstream infection

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

CVD:

Cerebral vascular disease

DM:

Diabetes mellitus

ICD:

International classification of diseases

IHD:

Ischemic heart disease

MALDI-TOF MS:

Matrix-assisted laser desorption ionization-time of flight mass spectrometry

NOMESCO:

Nordic medico-statistical committee

OR:

Odds ratio

PVD:

Peripheral vascular disease

SD:

Standard deviation

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Funding

This work was supported by unrestricted research grants from the Research Council and the Department of Cardiology at Herlev-Gentofte University Hospital; the Department of Cardiology at Zealand University Hospital Roskilde; Direktør Jacob Madsen’s og Hustru Olga Madsen’s fond; Helsefonden [Grant number 20-B-0340]; and Skibsreder Per Henriksen, R. og Hustrus Fond. The funders of the study were not involved in the study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark

    Sandra Chamat-Hedemand, Kamal Preet Kaur & Niels Eske Bruun

  2. Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark

    Sandra Chamat-Hedemand, Anders Dahl, Louise Bruun Oestergaard, Trine K. Lauridsen & Gunnar Gislason

  3. Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Lauge Østergaard & Emil Fosbøl

  4. Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark

    Lauge Østergaard

  5. Department of Clinical Microbiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark

    Magnus Arpi & Jonas Boel

  6. The Danish Heart Foundation, Copenhagen, Denmark

    Gunnar Gislason

  7. Institute of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark

    Gunnar Gislason & Niels Eske Bruun

  8. Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark

    Christian Torp-Pedersen

  9. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Christian Torp-Pedersen

  10. Clinical Institute, Aalborg University, Aalborg, Denmark

    Niels Eske Bruun

Authors
  1. Sandra Chamat-Hedemand
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  2. Anders Dahl
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  3. Lauge Østergaard
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  12. Niels Eske Bruun
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Contributions

SCH, AD, and NEB: Design of the project, analysis of data, draft of the manuscript. LØ, MA, EF, JB, KPK, LBO, TKL, GG, CTP: Design of the project, critical revision of data, reviewing and editing the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Sandra Chamat-Hedemand.

Ethics declarations

Conflict of interest

SCH, AD, LØ, MA, EF, JB, KPK, LBO, TKL, GG, CTP and NEB have no conflict of interest.

Ethical approval

The study was performed as a retrospective registry study, where all data were anonymised before use. All data used for this study are held by Statistics Denmark, which also has the administrative rights to the data and encrypts the identification number likewise in all datasets. In retrospective register studies in Denmark, ethics approval and individual consent is not required, and all methods were performed in accordance with the relevant guidelines and regulations. The data handling and storage in the project has been approved by the Danish Data Protection Agency (approval number 2007–58-015/GEH-2014–018 I-Suite number 02736).

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Supplementary Information

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Supplementary file1 (DOCX 102 KB)

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Chamat-Hedemand, S., Dahl, A., Østergaard, L. et al. Streptococcal species as a prognostic factor for mortality in patients with streptococcal bloodstream infections. Infection 51, 1513–1522 (2023). https://doi.org/10.1007/s15010-023-02025-8

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  • DOI: https://doi.org/10.1007/s15010-023-02025-8

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