2019-2021年咽峡炎链球菌群化脓性感染临床特点及其耐药性分析

Clinical characteristics and antibiotic resistance profiles of pyogenic infections caused by Streptococcus anginosus group from 2019 to 2021

目的探讨咽峡炎链球菌群化脓性感染临床特征及其耐药性。方法收集2019年1月-2021年12月汉中地区最大规模三级甲等医院咽峡炎链球菌群化脓性感染患者的临床资料进行回顾性统计分析。结果72例咽峡炎链球菌群化脓性感染患者中,男性49例,女性23例;平均年龄(48.7±20.3)岁;大部分患者白细胞计数、中性粒细胞绝对值、超敏C反应蛋白等炎性指标升高。15.3%患者住院期间行侵袭性操作,多数患者合并基础性疾病,如消化系统、呼吸系统、心血管系统疾病及糖尿病。咽峡炎链球菌群化脓性感染来源于胃肠道、上颌面部、皮肤软组织、腹腔内组织等,复数菌感染共29例,以合并大肠埃希菌等胃肠道菌群多见。脓液分离得72株咽峡炎链球菌群,对青霉素、氨苄西林、左氧氟沙星、万古霉素、利奈唑胺和头孢吡肟耐药率均<5%,而对克林霉素和红霉素耐药率均>70%。经治疗70例预后良好,死亡2例。结论咽峡炎链球菌群化脓性感染与侵袭性操作有关,临床表现无特异性,可合并其他病原菌感染。咽峡炎链球菌群对β内酰胺类抗生素敏感,对大环内酯类抗生素耐药。在临床治疗中,应合理规范使用抗生素,并对病灶进行外科治疗或脓肿引流。

Objective To investigate the clinical characteristics and antibiotic resistance profiles of pyogenic infections caused by Streptococcus anginosus group from January 2019 to December 2021.Methods Clinical data of patients with pyogenic infection caused by S.anginosus group were collected and analyzed retrospectively.Results A total of 72 patients were identified with pyogenic infection due to S.anginosus group,including 49 males and 23 females,mean age of 48.7±20.3 years.Most patients had biomarkers of infection,including increased white blood cell count,neutrophils,and high-sensitivity C-reactive protein.Invasive procedure was prevalent in 15.3%of the patients during hospital stay.Majority of the patients had underlying diseases such as digestive,respiratory,cardiovascular diseases,and diabetes mellitus.The pyogenic infections caused by S.anginosus group mostly originated from gastrointestinal tract,maxillofacial,skin soft tissue,and intraperitoneal tissue.Polymicrobial bacteremia was found in 29 patients,especially Escherichia coli.The 72 strains of S.anginosus group isolated from pus showed low resistance rate(<5%)to penicillin,ampicillin,levofloxacin,vancomycin,linezolid and cefepime,but higher resistance rate(>70%)to clindamycin and erythromycin.The outcome was satisfactory in 70 cases of infection,and 2 patients died.Conclusions The pyogenic infection caused by S.anginosus group is associated with invasive procedure and other bacterial co-infection.The clinical manifestations are not specific.The isolates of S.anginosus group are susceptible toβ-lactam antibiotics and resistant to macrolides.Rational antimicrobial therapy should be prescribed,in combination with surgical treatment or abscess drainage,to achieve best outcome.