1. S. bovis Bacteremia –
– Streptococcus bovis (in the category of group D strep) is a GI bug which can cause bacteremia through translocation when the GI tract becomes abnormal, either through instrumentation, from inflammatory conditions (as in IBD), or as a result of a GI malignancy.
– S bovis bacteremia has been associated with colorectal cancer in case series since the 1950s but also can be seen in other GI cancers such as esophageal cancer, pancreatic cancer, and stomach cancer.
– This is why finding a patient with S bovis bacteremia should set off an investigation for the aforementioned GI conditions.
– A recent reclassification of S. bovis divides this organism into biotypes I and II.
– S. bovis biotype I is now called Streptococcus gallolyticus which is important because biotype I has been found to have a higher risk of colorectal cancer when compared with biotype II.*
*Boleij A, van Gelder MM, Swinkles DW, et al. Clinical importance of Streptococcus gallolyticus infection among colorectal cancer patients: systematic review and meta-analysis. Clin Infect Dis. 2011;53(9):870-878.
2. Bacteremia and ICDs – thinking about when to take out, when to leave in**
-Situations where you definitely take out the device include: S. aureus bacteremia, endocarditis that is device related AKA lead infection, infections that perisist with positive cultures despite excluding other sources and treating with appropriate abx, pouch infections (may leave the leads on a case by case basis) and if the patient has undergone valvular surgery for endocarditis.
–Situations where you might try to leave the box and leads in place include: bacteremia from another source that has been adequately treated and where device-related endocarditis is excluded, for example by TTE (you still do surveillance cultures after tx), superficial infections of the pocket which don’t actually track in and involve the box, and situations where actually removing the device may be life threatening.
–The bacteremic patient with an ICD or pacemaker is definitely a situation where you want to work with ID and EP to come up with a multidisciplinary plan!