Open forum infectious diseases · 2026
The Clinical Significance of Streptococcus mitis Bacteremia.
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Acuff James H, Yang Erin H, Panchamukhi Ananth, Muldrew Kenneth L, Atmar Robert L, Musher Daniel M
Аннотация
BACKGROUND: Except for their role in bacterial endocarditis, nonpneumococcal Streptococcus mitis group (SMG) bacteria have traditionally been regarded as commensals of the oropharynx. Widespread adoption of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry has increased identification of these organisms and has led to increased concern about their clinical significance. We evaluated SMG bacteremia in a large multicenter cohort to characterize associated clinical syndromes and better define their clinical relevance.
METHODS: We performed a retrospective review of all adult patients from 2017 to 2025 who had SMG bacteremia at 3 hospitals within the Texas Medical Center. SMG bacteremia was defined as isolation of S mitis, S mitis/oralis, or S mitis group as determined by MALDI-TOF. Clinical syndromes were identified through chart review and assigned using consistent classification approaches informed by physician documentation, imaging, and microbiologic data.
RESULTS: Among 253 patients, neutropenia-associated bacteremia was most common (29.6%), followed by pneumonia (9.5%), infective endocarditis (8.7%), skin, soft tissue, or bone infections (7.9%), and other identified sources (12%). No clear source was identified in 9.5% of cases. Only 22.9% were classified as contaminants. High-grade bacteremia was common, with 47% of cases having ≥3 positive blood culture bottles. In contrast, patients in whom SMG was regarded as contaminant nearly always had only a single-bottle positive.
CONCLUSIONS: Streptococcus mitis group bacteremia was associated with a broad spectrum of clinical syndromes, with most isolates being regarded as representing clinically significant infection.
METHODS: We performed a retrospective review of all adult patients from 2017 to 2025 who had SMG bacteremia at 3 hospitals within the Texas Medical Center. SMG bacteremia was defined as isolation of S mitis, S mitis/oralis, or S mitis group as determined by MALDI-TOF. Clinical syndromes were identified through chart review and assigned using consistent classification approaches informed by physician documentation, imaging, and microbiologic data.
RESULTS: Among 253 patients, neutropenia-associated bacteremia was most common (29.6%), followed by pneumonia (9.5%), infective endocarditis (8.7%), skin, soft tissue, or bone infections (7.9%), and other identified sources (12%). No clear source was identified in 9.5% of cases. Only 22.9% were classified as contaminants. High-grade bacteremia was common, with 47% of cases having ≥3 positive blood culture bottles. In contrast, patients in whom SMG was regarded as contaminant nearly always had only a single-bottle positive.
CONCLUSIONS: Streptococcus mitis group bacteremia was associated with a broad spectrum of clinical syndromes, with most isolates being regarded as representing clinically significant infection.