From the Guidelines
Group C streptococci can cause endocarditis, although it is not explicitly mentioned as a common cause in the provided evidence. The American Heart Association recommendations for infective endocarditis in adults suggest coverage for various pathogens, including β-hemolytic streptococci, which Group C streptococci belong to, in patients with acute native valve infection 1. Key points to consider in the management of endocarditis include:
- Evaluation of epidemiological factors and clinical course to guide therapy
- Consultation with an infectious diseases specialist for culture-negative endocarditis
- Coverage for common pathogens based on the clinical presentation and valve type
- Revision of empirical therapy to focused therapy once a pathogen is identified
In the context of Group C streptococci causing endocarditis, treatment would likely involve intravenous antibiotics, such as penicillin G or ceftriaxone, for 4-6 weeks, with the possibility of adding gentamicin in complicated cases 1. It is essential to monitor patients closely with blood cultures, echocardiography, and clinical assessment to ensure treatment effectiveness and address potential complications, such as heart failure, embolic events, and valve destruction. The choice of antibiotic therapy should be guided by susceptibility testing and clinical response, with vancomycin being an alternative for patients with severe penicillin allergy.
From the Research
Group C Strep and Endocarditis
- Group C strep is a rare cause of human infections, but it can lead to endocarditis, as reported in a case study from 2.
- The study from 2 suggests that group C streptococcal endocarditis has a high potential for attachment to and destruction of normal heart valves, resulting in major emboli to vital organs and high mortality.
- Synergistic combinations of penicillin and an aminoglycoside may result in lower morbidity compared to penicillin used alone, as noted in the study from 2.
- Another study from 3 mentions that group C Streptococcus can cause endocarditis in pediatrics, although it is a rare occurrence.
Treatment of Endocarditis
- The treatment of endocarditis depends on the causative organism, with streptococci or staphylococci causing 75% of cases, as reported in the study from 4.
- For penicillin-sensitive viridans or nonenterococcal group D streptococcal endocarditis, treatment with aqueous penicillin G alone or combined with streptomycin may be effective, as stated in the study from 4.
- The study from 5 compared the efficacy of ceftriaxone monotherapy with combination therapy of ceftriaxone and gentamicin for the treatment of endocarditis due to penicillin-susceptible streptococci, and found both regimens to be effective and safe.
- The study from 6 evaluated various antibiotic combinations for the treatment of infective endocarditis caused by penicillin-resistant viridans group streptococci, and found that vancomycin-based regimens may be effective, but further clinical studies are needed to confirm this.