Relevance of group Milieri streptococci in thoracic surgery: A clinical update

I. Stelzmueller, M. Biebl, N. Berger, M. Eller, Julio C Mendez, M. Fille, K. Angerer, T. Schmid, I. Lorenz, R. Margreiter, H. Bonatti

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all β-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.

Original languageEnglish (US)
Pages (from-to)492-497
Number of pages6
JournalAmerican Surgeon
Volume73
Issue number5
StatePublished - May 2007

Fingerprint

Streptococcus milleri Group
Streptococcus
Thoracic Surgery
Empyema
Infection
Drainage
Thorax
Anti-Bacterial Agents
Esophageal Perforation
Lactams
Ceftazidime
Clindamycin
Aminoglycosides
Debridement
Pleural Effusion
Thoracotomy
Coinfection
Liver Transplantation
Heart Diseases
Recurrence

ASJC Scopus subject areas

  • Surgery

Cite this

Stelzmueller, I., Biebl, M., Berger, N., Eller, M., Mendez, J. C., Fille, M., ... Bonatti, H. (2007). Relevance of group Milieri streptococci in thoracic surgery: A clinical update. American Surgeon, 73(5), 492-497.

Relevance of group Milieri streptococci in thoracic surgery : A clinical update. / Stelzmueller, I.; Biebl, M.; Berger, N.; Eller, M.; Mendez, Julio C; Fille, M.; Angerer, K.; Schmid, T.; Lorenz, I.; Margreiter, R.; Bonatti, H.

In: American Surgeon, Vol. 73, No. 5, 05.2007, p. 492-497.

Research output: Contribution to journalArticle

Stelzmueller, I, Biebl, M, Berger, N, Eller, M, Mendez, JC, Fille, M, Angerer, K, Schmid, T, Lorenz, I, Margreiter, R & Bonatti, H 2007, 'Relevance of group Milieri streptococci in thoracic surgery: A clinical update', American Surgeon, vol. 73, no. 5, pp. 492-497.
Stelzmueller I, Biebl M, Berger N, Eller M, Mendez JC, Fille M et al. Relevance of group Milieri streptococci in thoracic surgery: A clinical update. American Surgeon. 2007 May;73(5):492-497.
Stelzmueller, I. ; Biebl, M. ; Berger, N. ; Eller, M. ; Mendez, Julio C ; Fille, M. ; Angerer, K. ; Schmid, T. ; Lorenz, I. ; Margreiter, R. ; Bonatti, H. / Relevance of group Milieri streptococci in thoracic surgery : A clinical update. In: American Surgeon. 2007 ; Vol. 73, No. 5. pp. 492-497.
@article{28bd9d2dc7784890a439486e8dd8c98b,
title = "Relevance of group Milieri streptococci in thoracic surgery: A clinical update",
abstract = "Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all β-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.",
author = "I. Stelzmueller and M. Biebl and N. Berger and M. Eller and Mendez, {Julio C} and M. Fille and K. Angerer and T. Schmid and I. Lorenz and R. Margreiter and H. Bonatti",
year = "2007",
month = "5",
language = "English (US)",
volume = "73",
pages = "492--497",
journal = "The American surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "5",

}

TY - JOUR

T1 - Relevance of group Milieri streptococci in thoracic surgery

T2 - A clinical update

AU - Stelzmueller, I.

AU - Biebl, M.

AU - Berger, N.

AU - Eller, M.

AU - Mendez, Julio C

AU - Fille, M.

AU - Angerer, K.

AU - Schmid, T.

AU - Lorenz, I.

AU - Margreiter, R.

AU - Bonatti, H.

PY - 2007/5

Y1 - 2007/5

N2 - Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all β-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.

AB - Group Milleri streptococci (GMS), a heterogeneous group of streptococci, are associated with purulent infections. This study was a retrospective analysis of all consecutive thoracic infections of GMS between 2001 and 2004. Of 246 surgical GMS infections, thoracic infections accounted for 4.5 per cent, including 10 pleural infections (eight empyemas and two infected pleural effusions) and one mediastinal infection. The etiology of pleural infection was parapneumonic (7), second to esophageal perforation (1), liver transplantation (1), and liver resection (1). Polymicrobial infections were present in 64 per cent. All patients underwent removal of the infected masses, including drainage (3), thoracoscopic decortication (5), thoracotomy with debridement (2), and incision with drainage (1). The case fatality rate was 9 per cent (there was one patient with congestive heart disease unfit to undergo surgical empyema evacuation) and the recurrence rate was 27.3 per cent (three patients). Combined antibiotic/surgical treatment was successful in all other cases. GMS isolates were susceptible to clindamycin and all β-lactam antibiotics except ceftazidime, but were resistant to aminoglycosides. If found intrathoracically, GMS frequently progress to severe empyema. Therefore, timely removal of pleural collection by percutaneous drainage or surgical intervention seems indicated. If surgery is required, thoracoscopic decortication may be the preferred approach.

UR - http://www.scopus.com/inward/record.url?scp=34250176915&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34250176915&partnerID=8YFLogxK

M3 - Article

C2 - 17521006

AN - SCOPUS:34250176915

VL - 73

SP - 492

EP - 497

JO - The American surgeon

JF - The American surgeon

SN - 0003-1348

IS - 5

ER -