title: The clinical epidemiology and malignancies associated with Streptococcus bovis biotypes in 506 cases of bloodstream infections.
abstract: OBJECTIVE
  To determine the incidence of Streptococcus bovis (Sb) biotypes causing bacteraemia and associated malignancies.
  
  
  METHODS
  This is a retrospective analysis of patients with Sb bacteraemia, pulled out from a prospective surveillance protocol of bacteraemia cases, in three areas of Spain (1990-2013): a cattle area (Lugo), a fishing area (Ferrol) and an urban area (Barcelona). Colonoscopy and Sb biotypes (Sb-I and Sb-II) were determined in most cases.
  
  
  RESULTS
  506 patients with Sb bacteraemia; mean age 68.1 (±14.1) years, and 66.2% were males. The cattle area, compared with the fishing and urban areas, had higher incidence of bacteraemia by SbI (40.29 vs 9.38 vs 6.15 cases/10(6) person-years, P < 0.001) and bacteraemia by Sb-II (29.07 vs 9.84 vs 13.37 cases/10(6) person-years, P < 0.001). The Sb-I cases (n = 224), compared with Sb-II cases (n = 270), had greater rates of endocarditis (77.6% vs 9.6%, P < 0.001) and colorectal neoplasm (CRN) (50.9% vs 16.6%, P < 0.001), and smaller rates of biliary tract infection (2.2% vs 29.6%, P < 0.001) and non-colorectal malignancy (8.9% vs 31.4%, P < 0.001).
  
  
  CONCLUSIONS
  There was a link between the cattle area and higher incidence of Sb bacteraemia. Sb-I differed from Sb-II cases in clinical findings and associated malignancies. Colonoscopy is mandatory in cases of endocarditis or bacteraemia caused by Sb-I.
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: juan.corredoira.sanchez@sergas.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Corredoira
authors.affiliation: Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain. Electronic address: igrau@idibell.cat.
authors.forename: Imma
authors.initials: I
authors.lastname: Grau
authors.affiliation: Infectious Disease Unit, Hospital Ferrol "Arquitecto Macide", Ferrol, Spain. Electronic address: Jose.Francisco.Garcia.Rodriguez@sergas.es.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Garcia-Rodriguez
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: Pilar.Alonso.Garcia@sergas.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Alonso-Garcia
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: Maria.Jose.Garcia.Pais@sergas.es.
authors.forename: M J
authors.initials: MJ
authors.lastname: Garcia-Pais
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: Ramon.Rabunal.Rey@sergas.es.
authors.forename: Ramon
authors.initials: R
authors.lastname: Rabuñal
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: garciagarrote@yahoo.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Garcia-Garrote
authors.affiliation: Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain. Electronic address: c.ardanuy@bellvitgehospital.cat.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ardanuy
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: amparo.coira.nieto@sergas.es.
authors.forename: Amparo
authors.initials: A
authors.lastname: Coira
authors.affiliation: Infectious Disease Unit and Microbiology Departments, Hospital Lugo "Lucus Augusti", Lugo, Spain. Electronic address: Maria.Jose.Lopez.Alvarez@sergas.es.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lopez-Alvarez
authors.affiliation: Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain. Electronic address: rpallares@ub.edu.
authors.forename: Roman
authors.initials: R
authors.lastname: Pallares
mesh_terms: D000368:Aged; D000818:Animals; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D015373:Bacterial Typing Techniques; D002417:Cattle; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D016985:Streptococcus bovis / Q000145:classification*; D013997:Time Factors
keywords: Bacteraemia; Biotypes; Colonoscopy; Colorectal neoplasm; Endocarditis; Malignancies; Mortality; Streptococcus bovis