Difference between revisions of "Viridans-Group Streptococci"

(Background)
(Antibiotic SensitivitiesSanford Guide to Antimicrobial Therapy 2010)
 
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==Background==
 
==Background==
 
*A [[Gram Positive Bacteria]] in the [[Streptococcus Genus]]
 
*A [[Gram Positive Bacteria]] in the [[Streptococcus Genus]]
*In general, low virulence pathogens and likely contaminants (21-50% of positive blood cultures are clinically significant) unless risk factor (see below)
+
*In general, low virulence pathogens and likely [[Blood Culture Contaminant]] unless risk factor (21-50% of positive blood cultures are clinically significant)<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>
  
 
==Types==
 
==Types==
**Streptococcus milleri
+
*Streptococcus milleri
**Streptococcus sanguis
+
*Streptococcus sanguis
**Streptococcus mitis
+
*Streptococcus mitis
**Streptococcus bovis
+
*Streptococcus bovis
  
==Risk Factors Viridans Bacteremia==
+
==Risk Factors for Viridans Bacteremia<ref>Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp</ref>==
 
*neutropenia
 
*neutropenia
 
*oral mucositis
 
*oral mucositis
 
*irradiation to the oral cavity
 
*irradiation to the oral cavity
*antibiotic prophylaxis with trimethoprim-sulfamethoxazole and fluoroquinolones
+
*antibiotic prophylaxis with trimethoprim-sulfamethoxazole or fluoroquinolones
 
*intravenous hyperalimentation
 
*intravenous hyperalimentation
 
*high dose chemotherapy
 
*high dose chemotherapy
  
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>==
+
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
 
{| class="wikitable"
 
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Organisms'''
+
| align="center" style="background:#f0f0f0;"|'''Category'''
| align="center" style="background:#f0f0f0;"|''''''
+
| align="center" style="background:#f0f0f0;"|'''Antibiotic'''
| align="center" style="background:#f0f0f0;"|'''Viridans strep'''
+
| align="center" style="background:#f0f0f0;"|'''[[Viridans strep]]'''
 
|-
 
|-
| Penicillins||Penicillin G||+/-
+
| [[Penicillins]]||[[Penicillin G]]||I
 
|-
 
|-
| ||Penicillin V||+/-
+
| ||[[Penicillin V]]||I
 
|-
 
|-
| Anti-Staphylocccal Penicillins||Methicillin||+/-
+
| ||[[Methicillin]]||I
 
|-
 
|-
| ||Nafcillin/Oxacillin||+/-
+
| ||[[Nafcillin]]/[[Oxacillin]]||I
 
|-
 
|-
| ||Cloxacillin/Diclox.||+/-
+
| ||[[Cloxacillin]]/[[Diclox.]]||I
 
|-
 
|-
| Amino-Penicillins||AMP/Amox||+/-
+
| Amino-[[Penicillins]]||[[AMP]]/[[Amox]]||I
 
|-
 
|-
| ||Amox/Clav||+/-
+
| ||[[Amox-Clav]]||I
 
|-
 
|-
| ||AMP-Sulb||+/-
+
| ||[[AMP-Sulb]]||I
 
|-
 
|-
| Anti-Pseudomonal Penicillins||Ticarcillin||+/-
+
| Anti-Pseudomonal [[Penicillins]]||[[Ticarcillin]]||I
 
|-
 
|-
| ||Ticar-Clav||+/-
+
| ||[[Ticar-Clav]]||I
 
|-
 
|-
| ||Pip-Taxo||+/-
+
| ||[[Pip-Tazo]]||I
 
|-
 
|-
| [[Carbapenems]]||Piperacillin||+/-
+
| ||Piperacillin||I
 
|-
 
|-
| ||Doripenem||+
+
| [[Carbapenems]]||Doripenem||S
 
|-
 
|-
| ||Ertapenem||+
+
| ||[[Ertapenem]]||S
 
|-
 
|-
| ||Imipenem||+
+
| ||[[Imipenem]]||S
 
|-
 
|-
| ||Meropenem||+
+
| ||[[Meropenem]]||S
 
|-
 
|-
| ||[[Aztreonam]]||0
+
| ||[[Aztreonam]]||R
 
|-
 
|-
| [[Fluroquinolones]]||[[Ciprofloxacin]]||0
+
| [[Fluroquinolones]]||[[Ciprofloxacin]]||R
 
|-
 
|-
| ||Ofloxacin||0
+
| ||[[Ofloxacin]]||R
 
|-
 
|-
| ||Pefloxacin||
+
| ||Pefloxacin||X1
 
|-
 
|-
| ||[[Levofloxacin]]||+
+
| ||[[Levofloxacin]]||S
 
|-
 
|-
| ||Moxifloxacin||+
+
| ||[[Moxifloxacin]]||S
 
|-
 
|-
| ||Gemifloxacin||+
+
| ||Gemifloxacin||S
 
|-
 
|-
| ||Gatifloxacin||+
+
| ||Gatifloxacin||S
 
|-
 
|-
| 1st G [[Cephalosporin]]||Cefazolin||+
+
| 1st G [[Cephalo]]||Cefazolin||S
 
|-
 
|-
| 2nd G. [[Cephalosporin]]||[[Cefotetan]]||+
+
| 2nd G. [[Cephalo]]||[[Cefotetan]]||S
 
|-
 
|-
| ||Cefoxitin||+
+
| ||[[Cefoxitin]]||S
 
|-
 
|-
| ||Cefuroxime||+
+
| ||[[Cefuroxime]]||S
 
|-
 
|-
| 3rd/4th G. [[Cephalosporin]]||[[CefoTAXime]]||+
+
| 3rd/4th G. [[Cephalo]]||[[Cefotaxime]]||S
 
|-
 
|-
| ||Cefizoxime||+
+
| ||Cefizoxime||S
 
|-
 
|-
| ||[[CefTRIAXone]]||+
+
| ||[[CefTRIAXone]]||S
 
|-
 
|-
| ||Ceftobiprole||+
+
| ||Ceftaroline||S
 
|-
 
|-
| ||Ceftaroline||+
+
| ||[[CefTAZidime]]||I
 
|-
 
|-
| ||[[CefTAZidime]]||+/-
+
| ||[[Cefepime]]||S
 
|-
 
|-
| ||[[Cefepime]]||+
+
| Oral 1st G. [[Cephalo]]||Cefadroxil||S
 
|-
 
|-
| Oral 1st G.  [[Cephalosporin]]||Cefadroxil||+
+
| ||[[Cephalexin]]||S
 
|-
 
|-
| ||[[Cephalexin]]||+
+
| Oral 2nd G. [[Cephalo]]||Cefaclor/Loracarbef||S
 
|-
 
|-
| Oral 2nd G.  [[Cephalosporin]]||Cefaclor/Loracarbef||+
+
| ||Cefproxil||R
 
|-
 
|-
| ||Cefproxil||0
+
| ||Cefuroxime axetil||S
 
|-
 
|-
| ||Cefuroxime axetil||+
+
| Oral 3rd G. [[Cephalo]]||Cefixime||S
 
|-
 
|-
| Oral 3rd G.  [[Cephalosporin]]||Cefixime||+
+
| ||Ceftibuten||R
 
|-
 
|-
| ||Ceftibuten||0
+
| ||Cefpodox/Cefdinir/Cefditoren||S
 
|-
 
|-
| ||Cefpodox/Cefdinir/Cefditoren||+
+
| [[Aminoglycosides]]||[[Gentamicin]]||X1
 
|-
 
|-
| [[Aminoglycosides]]||[[Gentamicin]]||
+
| ||Tobramycin||X1
 
|-
 
|-
| ||Tobramycin||
+
| ||[[Amikacin]]||X1
 
|-
 
|-
| ||[[Amikacin]]||
+
| ||[[Chloramphenicol]]||X1
 
|-
 
|-
| ||Chloramphenicol||
+
| ||[[Clindamycin]]||X1
 
|-
 
|-
| ||[[Clindamycin]]||
+
| [[Macrolides]]||Erythromycin||X1
 
|-
 
|-
| [[Macrolides]]||Erythromycin||
+
| ||[[Azithromycin]]||X1
 
|-
 
|-
| ||[[Azithromycin]]||
+
| ||Clarithromycin||X1
 
|-
 
|-
| ||Clarithromycin||
+
| Ketolide||Telithromycin||X1
 
|-
 
|-
| Ketolide||Telithromycin||
+
| Tetracyclines||[[Doxycycline]]||X1
 
|-
 
|-
| Tetracyclines||[[Doxycycline]]||
+
| ||Minocycline||X1
 
|-
 
|-
| ||Minocycline||
+
| Glycylcycline||Tigecycline||X1
 
|-
 
|-
| Glycylcycline||Tigecycline||
+
| ||Daptomycin||X1
 
|-
 
|-
| Glyco/Lipoclycopeptides||[[Vancomycin]]||
+
| Glyco/Lipoclycopeptides||[[Vancomycin]]||X1
 
|-
 
|-
| ||Teicoplanin||
+
| ||Teicoplanin||X1
 
|-
 
|-
| ||Telavancin||
+
| ||Telavancin||X1
 
|-
 
|-
| ||Fusidic Acid||
+
| ||Fusidic Acid||X1
 
|-
 
|-
| ||Trimethoprim||
+
| ||Trimethoprim||X1
 
|-
 
|-
| ||[[TMP-SMX]]||
+
| ||[[TMP-SMX]]||X1
 
|-
 
|-
| Urinary Agents||[[Nitrofurantoin]]||
+
| Urinary Agents||[[Nitrofurantoin]]||X1
 
|-
 
|-
| ||Fosfomycin||
+
| ||Fosfomycin||X1
 
|-
 
|-
| Other||[[Rifampin]]||
+
| Other||[[Rifampin]]||X1
 
|-
 
|-
| ||[[Metronidazole]]||
+
| ||[[Metronidazole]]||X1
 
|-
 
|-
| ||Quinupristin dalfoppristin||
+
| ||Quinupristin dalfoppristin||X1
 
|-
 
|-
| ||Linezolid||
+
| ||[[Linezolid]]||X1
 
|-
 
|-
| ||[[Daptomycin]]||
+
| ||Colistimethate||X1
|-
 
| ||Colistimethate||
 
 
|}
 
|}
 
 
===Key===
 
===Key===
 
{{Template:Antibacterial Spectra Key}}
 
{{Template:Antibacterial Spectra Key}}

Latest revision as of 06:30, 3 June 2014

Background

Types

  • Streptococcus milleri
  • Streptococcus sanguis
  • Streptococcus mitis
  • Streptococcus bovis

Risk Factors for Viridans Bacteremia[2]

  • neutropenia
  • oral mucositis
  • irradiation to the oral cavity
  • antibiotic prophylaxis with trimethoprim-sulfamethoxazole or fluoroquinolones
  • intravenous hyperalimentation
  • high dose chemotherapy

Antibiotic Sensitivities[3]

Category Antibiotic Viridans strep
Penicillins Penicillin G I
Penicillin V I
Methicillin I
Nafcillin/Oxacillin I
Cloxacillin/Diclox. I
Amino-Penicillins AMP/Amox I
Amox-Clav I
AMP-Sulb I
Anti-Pseudomonal Penicillins Ticarcillin I
Ticar-Clav I
Pip-Tazo I
Piperacillin I
Carbapenems Doripenem S
Ertapenem S
Imipenem S
Meropenem S
Aztreonam R
Fluroquinolones Ciprofloxacin R
Ofloxacin R
Pefloxacin X1
Levofloxacin S
Moxifloxacin S
Gemifloxacin S
Gatifloxacin S
1st G Cephalo Cefazolin S
2nd G. Cephalo Cefotetan S
Cefoxitin S
Cefuroxime S
3rd/4th G. Cephalo Cefotaxime S
Cefizoxime S
CefTRIAXone S
Ceftaroline S
CefTAZidime I
Cefepime S
Oral 1st G. Cephalo Cefadroxil S
Cephalexin S
Oral 2nd G. Cephalo Cefaclor/Loracarbef S
Cefproxil R
Cefuroxime axetil S
Oral 3rd G. Cephalo Cefixime S
Ceftibuten R
Cefpodox/Cefdinir/Cefditoren S
Aminoglycosides Gentamicin X1
Tobramycin X1
Amikacin X1
Chloramphenicol X1
Clindamycin X1
Macrolides Erythromycin X1
Azithromycin X1
Clarithromycin X1
Ketolide Telithromycin X1
Tetracyclines Doxycycline X1
Minocycline X1
Glycylcycline Tigecycline X1
Daptomycin X1
Glyco/Lipoclycopeptides Vancomycin X1
Teicoplanin X1
Telavancin X1
Fusidic Acid X1
Trimethoprim X1
TMP-SMX X1
Urinary Agents Nitrofurantoin X1
Fosfomycin X1
Other Rifampin X1
Metronidazole X1
Quinupristin dalfoppristin X1
Linezolid X1
Colistimethate X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

See Also

References

  1. Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp
  2. Antibiotic Therapy for Positive Blood Cultures. Perez-Jorge EV, et al. Antimicrobe. http://www.antimicrobe.org/new/e38rev2.asp
  3. Sanford Guide to Antimicrobial Therapy 2014