Background Streptococcal bacteremia is associated with high mortality. The study aims to identify predictors of mortality among patients with streptococcal bacteremia. Methods This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included episodes of streptococcal bacteremia among adult patients from 2015 to 2023. Results During the study period, 861 episodes of streptococcal bacteremia were included. The majority of episodes were categorized in the Mitis group (348 episodes; 40%), followed by the Pyogenic group (215; 25%). Endocarditis was the most common source of bacteremia (164; 19%). The overall 14-day mortality rate was 8% (65 episodes). The results from the Cox multivariable regression model showed that a Charlson comorbidity index >4 (P 0.001; HR 2.87, CI 1.58-5.22), S. pyogenes (P 0.011; HR 2.54, CI 1.24-5.21), sepsis (P < 0.001; HR 7.48, CI 3.86-14.47), lower respiratory tract infection (P 0.002; HR 2.62, CI 1.42-4.81), and absence of source control interventions within 48 hours despite being warranted (P 0.002; HR 2.62, CI 1.43-4.80) were associated with 14-day mortality. Conversely, interventions performed within 48 hours of bacteremia onset, such as infectious diseases consultation (P < 0.001; HR 0.29, CI 0.17-0.48), and appropriate antimicrobial treatment (P < 0.001; HR 0.28, CI 0.14-0.57) were associated with improved outcome. Conclusions Our findings underscore the pivotal role of infectious diseases consultation in guiding antimicrobial treatment and recommending source control interventions for patients with streptococcal bacteremia.

中文翻译：

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链球菌菌血症死亡率的预测因子和传染病咨询的作用；回顾性队列研究

背景 链球菌菌血症与高死亡率相关。该研究旨在确定链球菌菌血症患者死亡率的预测因素。方法 这项回顾性研究在瑞士洛桑大学医院进行，纳入了 2015 年至 2023 年成年患者的链球菌菌血症发作情况。结果 在研究期间，共纳入了 861 例链球菌菌血症发作情况。大多数发作属于 Mitis 组（348 次发作；40%），其次是化脓性组（215 次；25%）。心内膜炎是菌血症最常见的来源（164；19%）。 14 天总体死亡率为 8%（65 次发作）。 Cox多变量回归模型的结果显示，查尔森合并症指数>4（P<0.001；HR 2.87，CI 1.58-5.22），化脓性链球菌（P<0.011；HR 2.54，CI 1.24-5.21），脓毒症（P< ；0.001；HR 7.48，CI 3.86-14.47），下呼吸道感染（P <0.002；HR 2.62，CI 1.42-4.81），以及尽管有必要但 48 小时内未采取源头控制干预措施（P <0.002；HR 2.62，CI 1.43） -4.80）与 14 天死亡率相关。相反，菌血症发作后 48 小时内进行的干预措施，例如传染病咨询（P < 0.001；HR 0.29，CI 0.17-0.48）和适当的抗菌治疗（P < 0.001；HR 0.28，CI 0.14-0.57），与改善结果相关。结论 我们的研究结果强调了传染病咨询在指导链球菌菌血症患者抗菌治疗和推荐源头控制干预措施方面的关键作用。