Clinical relevance of viridans and nonhemolytic streptococci isolated from blood and cerebrospinal fluid in a pediatric population.

Laboratory records were reviewed to assess the clinical relevance of isolating viridans (VS) and nonhemolytic (NHS) streptococci from blood and cerebrospinal fluid (CSF) specimens in a pediatric setting. During a nine-month period, 722 of 6,569 blood cultures and 113 of 2,023 CSF cultures were positive for one or more organisms. There were 26 VS and 10 NHS blood isolates from 30 patients and five NHS isolates from the CSF of five additional patients. The patients ranged in age from five weeks to 16 years. The charts of 34 patients were reviewed for evidence of sepsis or meningitis and the physician's response to the positive cultures. Three patients had subacute bacterial endocarditis (SBE) with multiple positive blood cultures. All other patients, including six oncology patients, failed to show a positive correlation between the isolation of VS or NHS and the disease process. Speciation and MIC testing were performed on 13 isolates, including those from all SBE and four oncology patients. Because of the lack of significance of VS and NHS from blood and CSF specimens in patients other than those with SBE, the authors conclude that extensive microbiologic workup of VS and NHS is not necessary without appropriate clinical indications such as SBE or immunosuppression.