P-797. Novel Solution to Increase GI Screening in Patients with Streptococcus gallolyticus Bacteremia

TL;DR

This study shows that adding a note to microbiology reports can help increase colorectal cancer screening in patients with a specific type of bacterial infection.

Contribution

A templated microbiology comment was implemented to improve CRC screening rates in patients with S. gallolyticus bacteremia.

Findings

Only 34.2% of patients received colonoscopies before the intervention, compared to 33% after the intervention.

The templated comment led to 100% CRC evaluation recommendations in the post-intervention group.

Echocardiograms were completed in 100% of post-intervention cases, showing improved diagnostic follow-up.

Abstract

Streptococcus gallolyticus bacteremia is linked to colorectal cancer (CRC). Despite its high correlation, many patients do not receive CRC screening. We present our multi-phasic care improvement project evaluating care gaps in CRC screening and subsequent implementation of a templated microbiology comment to improve clinical decision-making for patients with S. gallolyticus bacteremia.

Phase 1 was a retrospective, multi-site cohort study of adults admitted to Saint Luke’s Health System from January 1, 2015 to April 30, 2023 with S. gallolyticus isolated in ≥1 blood cultures. The primary endpoint was documented CRC evaluation via colonoscopy within 6 months of the first positive culture. Secondary endpoints included infectious disease (ID) or gastroenterology (GI) consults, diagnostic imaging (e.g., computed tomography abdomen/pelvis [CTAP], echocardiogram [ECHO]), and documented CRC screening recommendations. Phase 2 involved evaluation and deployment of a templated comment, stating: “Streptococcus gallolyticus (formerly S. bovis) bacteremia may warrant further GI evaluation” on the culture result to nudge CRC screening. Phase 3 was a post-intervention assessment of patients with S. gallolyticus bacteremia admitted between Feb 1, 2024 and December 31, 2024 with similar outcomes as in Phase 1.

In Phase 1, 38 patients met inclusion criteria. CRC evaluation was recommended in 65.7% of cases and colonoscopy completed in 34.2%. ID and GI were consulted in 76.3% and 44.7% of patients, respectively. CTAP and ECHO were completed during admission in 47.4% and 81.6% of cases. In Phase 3, 6 patients met criteria with CRC evaluation recommended in 100% and completed in 33%. ID and GI consults occurred in 83.3% and 50% of cases while CTAP and ECHO were completed in 66.7% and 100%, respectively.

Embedding a comment within microbiology results appears to be a high-impact strategy to enhance CRC screening in patients with S. gallolyticus bacteremia. Our findings emphasize gaps between recommended and completed screenings, but early post-intervention data suggest improved clinician awareness. Continued evaluation is warranted to determine long-term effectiveness of this intervention.

All Authors: No reported disclosures