Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

Abstract

Bacterial infections are a serious complication of end-stage liver disease (ESLD) that occurs in 20% to 60% of patients. We retrospectively reviewed medical records of patients with ESLD who were identified by our microbiology laboratory as having Streptococcus salivarius bacteremia. Of 592 patients listed for transplantation between January 1998 and January 2006, 9 (1.5%) had 10 episodes of S salivarius bacteremia. Of 2 patients already receiving quinolone prophylaxis for spontaneous bacterial peritonitis (SBP), 1 later presented with a second episode. The male-to-female ratio was 1:1.2. Medians for age, Model for End-Stage Liver Disease score, and Child-Turcotte-Pugh score were 50 years, 17, and 10, respectively. Presenting symptoms and signs in 10 episodes of infection were ascites (in 8 episodes), elevated temperature (6), abdominal pain (5) Bacterial infections are a common and serious complication of end-stage liver disease (ESLD). Their prevalence has been reported to range from 20 to 60%. 1,2 They are associated with increased morbidity and overall in-hospital mortality.1,2 Proposed mechanisms for increased risk of infection are changes in humoral immunity with a decreased synthesis in the complement system, 3 a decrease in the phagocytosis capability of the hepatic reticuloendothelial system, 4 an alteration in the function of neutrophils, 5,6 and a reduction in opsonic activity of ascitic fluid. 7 In addition, rupture of natural barriers induced by invasive diagnostic or therapeutic procedures may be involved in the pathogenesis of infections.Commonly observed infections in cirrhotic patients are pneumonia, urinary tract infection, spontaneous bacterial peritonitis (SBP), and bacteremia. Most of these infections are community acquired. In 1 series, two-thirds of the episodes were caused by gram-negative bacteria, 21% by gram-positive bacteria, and 3% by anaerobic bacteria. 8 In a more recent series of 117 cases of bacteremia, about one-half of the infections were caused by gram-negative bacteria and about onehalf by gram-positive bacteria. 9 We have encountered cases of S salivarius bacteremia among patients listed for liver transplantation at our tertiary care academic medical institution. Herein, we present our experience with this infection in patients with ESLD who were managed at our institution. PATIENTS AND METHODSAfter we encountered 2 liver transplantation candidates with S salivarius bacteremia, we reviewed the electronic Abbreviations: ESLD, end-stage liver disease; SBP, spontaneous bacterial peritonitis; VGS, viridans group streptococci.

Reply: Viridans group streptococci causing spontaneous bacterial peritonitis and bacteremia in patients with end-stage liver disease

“…There are demographic similarities between the patients reported previously by Gautam et al 1 and the patients reported by Bert et al 2 in their letter to the editors in this issue of Liver Transplantation. We elected to concentrate on patients who presented with Streptococcus salivarius bacteremia after we had encountered a few such patients in our clinical practice.…”

Identification of bacterial DNA in neutrocytic and non‐neutrocytic cirrhotic ascites by means of a multiplex polymerase chain reaction

“…Coagulase-negative staphylococci, group B streptococci and viridans group streptococci (VGS) have also been detected in SBP (25,17,19). Despite reports of an increasing incidence of VGS-associated SBP (26), S. salivarius is detected in ascite culture from o1% (3/ 592) of patients with end-stage liver disease (27) and current studies identify VGS in 7% of patients with SBP (25). Although the applied multiplex PCR kit does not identify certain VGS (S. oralis, S. mitis, S. salivarius, S. gordonii and S. vestibularis), Aeromonas spp.…”

Identification of Clinically Relevant Nonhemolytic Streptococci on the Basis of Sequence Analysis of 16S-23S Intergenic Spacer Region and Partial gdh Gene

“…Among the members of the salivarius group, only S. salivarius is commonly identified from a variety of human infections (4,13,21). S. thermophilus has been isolated only from dairy products.…”