Streptococcus Anginosus Infections

Diagnosis and Treatment

Patients with suspected Streptococcus anginosus infections should undergo urgent surgical exploration of the suspected site and complete debridement of infected tissue, as recommended by the American Heart Association 1
Tissue cultures should be obtained, and if positive, a full course of antibiotics should be completed after surgery, while if negative, pre-surgical antibiotic days can be counted towards the total duration, as suggested by the American Heart Association 2
Blood cultures should be taken every 24-48 hours until clearance, and repeated imaging studies should be performed in patients with persistent bacteremia to identify undrained infection foci, as recommended by the American Heart Association 2
Consultation with an infectious disease specialist is recommended to define the optimal empirical treatment regimen, according to the American Heart Association 2

The duration of antibiotic therapy for invasive infections, such as mediastinitis, should be at least 4 weeks, as recommended by the American Heart Association and the European Society of Cardiology 1, 3
For genital infections, treatment options include:
For children under 8 years, tetracyclines should be avoided, as recommended by the Centers for Disease Control and Prevention 4
First-line treatment options include:
Alternative treatment options include:

Incision and drainage plus antibiotics should be considered if an abscess is present in patients with Streptococcus anginosus genital infections, as recommended by the American College of Obstetricians and Gynecologists 4
Sexual partners should be evaluated for potential colonization or infection, and considered for treatment if recurrent infections occur, as recommended by the Centers for Disease Control and Prevention 4
The S. anginosus group has a propensity to form abscesses, requiring surgical drainage in addition to antibiotics, as recommended by the American Heart Association 2
Invasive infections, such as endocarditis and abscesses, require a minimum treatment duration of 4 weeks, as recommended by the American Heart Association and the European Society of Cardiology 2, 3
Localized infections, such as pharyngitis, require a treatment duration of 10 days, according to the American Academy of Pediatrics 8

Misdiagnosing Streptococcus anginosus genital infections as simple candidiasis or bacterial vaginosis, inadequate treatment duration, failure to drain abscesses when present, and not considering underlying conditions that may predispose to infection should be avoided, as warned by the Centers for Disease Control and Prevention 4
Infectious disease consultation is strongly recommended to define the optimal empirical treatment regimen at the initiation of antimicrobial therapy, according to the American Heart Association 2