Streptococcal, Non-Group A Infections

Non-group A hemolytic streptococci (eg, groups B, C, and G) produce a spectrum of disease similar to that of group A beta-hemolytic streptococci

Viridans streptococci are part of the normal oral flora but may produce focal pyogenic infection

Group B streptococci

• An important cause of sepsis, bacteremia, and meningitis in the neonate

• Antepartum screening vaginal cultures are recommended to identify carrier mothers

• May cause septic abortion, endometritis, or peripartum infections in women and, less commonly, cellulitis, bacteremia, and endocarditis in adults

Group D streptococci

• Include Streptococcus bovis and the enterococci

• S bovis is a cause of endocarditis in association with colorectal cancer or cirrhosis

Viridans streptococci

• Nonhemolytic or alpha-hemolytic (ie, producing a green zone of hemolysis on blood agar)

• Leading cause of native valve endocarditis

Culture of affected site or blood

Non-group A hemolytic streptococci (eg, groups B, C, and G

• Give penicillin G aqueous, 4 million units every 4 hours intravenously

• Vancomycin, 1 g intravenously every 12 hours, is recommended for persons allergic to penicillin

Group B streptococci

• Addition of low-dose gentamicin, 1 mg/kg every 8 hours is recommended by some experts because of in vitro synergism

• Peripartum antimicrobial prophylaxis is recommended

Viridans streptococci

• Give penicillin with or without addition of gentamicin

• Alternatives are cephalosporin and vancomycin

S bovis infection treated like viridans streptococci