Colonic neoplasm detection in patients with <i>Streptococcus gallolyticus</i> septicaemia versus average-risk individuals: a retrospective matched cohort study from a tertiary care center in Thailand.

Abstract

To compare colorectal neoplasm detection rates between patients with <i>Streptococcus gallolyticus</i> septicaemia and average-risk individuals undergoing screening colonoscopy and identify predictors of neoplasm detection within the septicaemia group. A retrospective matched cohort study SETTING: Tertiary care university hospital in Southern Thailand. Eighty-five patients with <i>S. gallolyticus</i> septicaemia and 279 average-risk individuals who underwent colonoscopy between 2014 and 2024. Outcomes included the polyp detection rate (PDR), adenoma detection rate (ADR), advanced adenoma detection rate (aADR) and adenocarcinoma detection rate. Logistic regression was used to estimate ORs with 95% CIs. In an unmatched analysis, the ADR (41.2% vs 26.9%, OR 1.90, 95% CI 1.15 to 3.16, p=0.014) and adenocarcinoma detection rate (12.9% vs 2.9%, OR 5.04, 95% CI 1.95 to 12.97, p<0.001) were significantly higher in the septicaemia group, whereas the PDR and aADR were not significantly different. In the age- and sex-matched analysis (n=50 pairs), detection rates were comparable, except for a lower PDR in the septicaemia group (44% vs 70%, OR 0.34, 95% CI 0.14 to 0.76, p=0.008). Subgroup analysis within the septicaemia group identified older age (adjusted OR 1.04 per year, 95% CI 1.01 to 1.08, p=0.023) and diabetes mellitus (adjusted OR 2.79, 95% CI 1.15 to 6.81, p=0.034) as independent predictors of colonic neoplasm detection. Importantly, colonoscopy performed <b>after</b> the septicaemia episode was independently associated with a markedly higher likelihood of neoplasm detection than procedures done <b>before</b> septicaemia (adjusted OR 4.88, 95% CI 1.70 to 14.05, p=0.002), indicating that repeat colonoscopy may be warranted even in patients who had undergone the procedure within the previous 6 months. <i>S. gallolyticus</i> septicaemia was linked to higher adenoma and adenocarcinoma detection rates, with age and diabetes mellitus further increasing such risk. Even patients who underwent colonoscopy within 6 months before septicaemia benefited from repeat colonoscopy, supporting its consideration to prevent missed or rapidly developing lesions.