{
  "abstract": "Introduction Streptococcus gallolyticus bacteraemia is associated with colorectal neoplasia and malignancy, however the existing literature reports wide-ranging rates of correlation between 6 and 71%. In addition, there is no prior research which examines the significance of the colorectal pathology found in light of recent polyp surveillance guidelines. As the exact strength of the link and rates of significant neoplasia are unclear, there is no clear consensus on the appropriate investigation of these patients. We aimed to establish the prevalence of significant colorectal neoplasia in patients with Streptococcus gallolyticus bacteraemia in NHS Lothian and assess its utility as trigger for colorectal investigation.Methods The studied population is patients aged 18 and over in NHS Lothian with a positive blood culture for Streptococcus gallolyticus from October 2014 to April 2024. These data were obtained from the microbiology database. Retrospective electronic patient medical record analysis was carried out., and demographic and clinical information extracted. The colonoscopy reports were analysed manually and compared to the British Society for Gastroenterology’s post-polypectomy guidelines. These data were analysed and compared to the Scottish age-specific incidence rates of colorectal cancer.Results 143 positive blood culture samples for Streptococcus gallolyticus were identified, concerning 104 individual patients (59.6% male). Mean age was 74.4 years (SD 13.2 years). 30-day mortality was 14.4%, and 1 year mortality was 41.3%. 20 patients (19.2%) were diagnosed with endocarditis, none of whom were found to have colorectal malignancy. A colorectal source of infection identified in13 patients (12.5%). 68 patients (65.4%) underwent colorectal investigation – 10/68 (14.7%) with colonoscopy alone, 48/68 (70.6%) with CT imaging alone, and 10/68 (14.7%) with both modalities. Among those investigated, 5/68 (7.35%) had colorectal malignancy (compared to an incidence rate of 0.228% of colorectal cancer in Scotland among those aged 70-74 – giving a z-score of 9.76 (p<1x10-21)). A further 5/68 (7.35%) had adenomas with high-risk features. Thus 14.7% of patients investigated had colonic pathology which required either treatment or surveillance.Conclusions Although we found a lower prevalence of significant colorectal neoplasia in patients with Streptococcus gallolyticus bacteraemia than that reported in the literature, it remains significantly higher than in the general population. Given the high sensitivity of quantitative faecal immunochemical testing (qFIT) for detecting colorectal neoplasia, the role of qFIT could be investigated in this cohort.References Rutter et al, Post-polypectomy and post-colorectal cancer resection surveillance guidelines, Gut 2020.Cancer incidence in Scotland - to December 2023 - Cancer incidence in Scotland - Publications - Public Health Scotland.",
  "authors": [
    {
      "affiliations": [
        "NHS Fife, Edinburgh, United Kingdom"
      ],
      "name": "Daniel Newton"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, United Kingdom"
      ],
      "name": "Rabbiaa Imawana-Tutter"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, United Kingdom"
      ],
      "name": "Benjamin Shandro"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, United Kingdom"
      ],
      "name": "Surabhi Taori"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, United Kingdom"
      ],
      "name": "Rahul Kalla"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, United Kingdom"
      ],
      "name": "Edinburgh GI Audit and Research"
    }
  ],
  "title": "P321 An examination of the association between Streptococcus gallolyticus bacteraemia and significant colorectal neoplasia in NHS Lothian",
  "uid": "8ab60739-d361-5255-9ff4-9b239ec6cb16"
}