Clinical characteristics and mortality risk factors of Streptococcus constellatus infection: A retrospective cohort study of 390 patients

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BACKGROUND: Few studies have investigated the clinical characteristics and mortality associated with Streptococcus constellatus (S.constellatus) infection. To identify the clinical features and mortality of patients with S. constellatus infection. METHODS: This retrospective cohort study analyzed hospitalized patients with confirmed S.constellatus infection at West China Hospital of Sichuan University from January 2016 to April 2024. S. constellatus was identified using sterile body fluid culture or metagenomic next-generation sequencing (mNGS). Patients were categorized as monomicrobial or polymicrobial infection. Kaplan-Meier curve analysis was performed to compare the 30-day survival rates based on infection type and infection site, while multivariate Cox regression was conducted to identify independent risk factors for 30-day mortality. RESULTS: Of the 390 patients, 301 (77.2 %) were classified as monomicrobial S. constellatus infection. S. constellatus isolates were highly susceptible to penicillin (98.08 %) and levofloxacin (98.90 %).Overall 30- and 90-day mortality were 13.08 % and 15.13 %, higher in polymicrobial than monomicrobial infections (24.72 % vs 8.97 % at 30 days; 29.21 % vs 10.96 % at 90 days). Polymicrobial infection (adjusted hazard ratio [aHR] = 2.426, p = 0.007) and brain abscess (aHR = 16.689, p < 0.001) were identified as independent risk factors for 30-day mortality in patients with S. constellatus infection. In the subgroup of monomicrobial infection, mediastinal abscess (aHR = 6.738, p = 0.002) and brain abscess (aHR = 13.933, p < 0.001) were significantly associated with an increased risk of 30-day mortality. CONCLUSIONS: Although S. constellatus was highly susceptible to antibiotics, short-term mortality remained substantial. Infection site and polymicrobial infection were key prognostic factors in patients with S. constellatus infection.

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