What is the next step when a patient’s urine culture shows -hemolytic streptococci?
What is the next step when a patient's urine culture shows ß-hemolytic streptococci?
-Joseph Schube, MD
Yorba Linda, Calif
I share your puzzlement. The group A ß-hemolytic streptococcus(Streptococcus pyogenes) is not ordinarily consideredto be a urinary pathogen, and I am aware of nounique syndromes or implications associated withgroup A streptococci in urine cultures. However, the answersto the following 3 questions may prove helpful:
If the patient had asymptomatic bacteriuria, I wouldrepeat the culture and, if the culture were confirmed,possibly prescribe a short course of a ß-lactam antibiotic.Assuming the patient had normal renal function, oral penicillinV would be a good choice; like most ß-lactam antibiotics,it is eliminated mainly by renal excretion.-
Charles S. Bryan, MD
Professor of Medicine
Director, Division of Infectious Diseases
University of South Carolina School of Medicine