Abstract
Introduction: The association between Streptococcus bovis (S. bovis) bacteremia and colorectal cancer is well established. We aimed to review patients with S. bovis bacteremia in the Hamilton Regional Hospitals and determine the percentage of patients referred for colonoscopy. Methods: We searched the Hamilton Regional Laboratory Medicine Program database to identify S.bovis-positive blood cultures from January 2002 to December 2016. The records of patients with S. bovis bacteremia were reviewed and clinical data extracted. Clinical characteristics were analyzed using descriptive statistics. Univariate logistic regression analysis was performed to examine the association of clinical characteristics with a finding of adenocarcinoma or adenomatous polyps. Results: A total of 86 patients with S. bovis bacteremia were identified. From the 86 patients 14 were excluded (3 were made palliative, 6 had insufficient data, 4 were <18 years of age, and 1 was known to have CRC). The mean age of the 72 remaining patients was 74.5 (SD 13), 42/72 (58%) were male, 12/72 (17%) had infective endocarditis, and 19 (26%) died during admission. Of the 53 patients who survived, 37 (70%) were referred for colonoscopy or CT colonography, of which 30 had a colonoscopy. 3/30 (10%) cases showed adenocarcinoma and 11/30 (37%) cases showed adenomatous polyps. Using logistic regression, age, gender, or presence of infective endocarditis were not associated with a finding of adenocarcinoma or adenomatous polyps. Referral to gastroenterology was significantly associated with having a colonoscopy (p=0.001). Conclusion: In our local centers, only 70% of patients with S. bovis bacteremia were referred for colonoscopy or CT colonography, however, we did not have records from outside of our hospitals. Colonoscopy should be strongly considered as 10% of patients who had a colonoscopy were found to have adenocarcinoma with an additional 37% having adenomatous polyps.262 Figure 1. Flow diagram
Highlights
Streptococcus bovis (S. bovis) is a Gram-positive group D streptococcus found in the gastrointestinal tract of 11% of asymptomatic patients [1]
In 1977, Klein et al found an association between S. bovis fecal carriage and colorectal cancer (CRC) [4], which was supported by a recent 2014 meta-analysis demonstrating that fecal carriage of S. bovis is 2-fold greater in patients with a colorectal neoplasm [1]
The objective of this study was to determine the percentage of patients referred for colonoscopy after a S. bovis bacteremia at our local centres
Summary
Streptococcus bovis (S. bovis) is a Gram-positive group D streptococcus found in the gastrointestinal tract of 11% of asymptomatic patients [1]. In 1977, Klein et al found an association between S. bovis fecal carriage and CRC [4], which was supported by a recent 2014 meta-analysis demonstrating that fecal carriage of S. bovis is 2-fold greater in patients with a colorectal neoplasm (carcinoma or adenoma) [1]. This was further supported by Paritsky et al who found malignant tumors in 35% of patients colonized with S. bovis, while none were found in those without [5]. The pathogenesis of CRC in the setting of S. bovis may involve its high affinity for type IV collagen found in colonic mucosa and by the production of proinflammatory cytokines (NF-κB, interleukin-1, interleukin-8, and cyclooxygenase-2) promoting proliferation and angiogenesis, while inhibiting apoptosis [6]
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