9例咽峡炎链球菌致脓胸的临床特征分析

Analysis of clinical characteristics in 9 cases of empyema caused by Streptococcus anginosus

目的探讨咽峡炎链球菌(SA)致脓胸的临床特点。方法回顾性分析2016年1月至2023年9月西安医学院第一附属医院收治的9例SA致脓胸患者资料,总结其临床特征。结果9例患者中男8例,女1例,年龄(60.8±12.8)岁,均有基础疾病,同时伴有发热、咳痰、胸痛、呼吸困难,发病时间(6.1±2.2)d,住院时间(19.33±7.48)d。9例患者均表现为血清WBC、C反应蛋白(CRP)、降钙素原(PCT)、血浆D-二聚体(D-D)、胸腔积液乳酸脱氢酶(LDH)升高,血清白蛋白(ALB)和胸腔积液葡萄糖(GLU)下降,大部分患者胸腔积液腺苷脱氨酶(ADA)升高,4例患者出现呼吸衰竭。药敏试验提示5例患者对红霉素和克林霉素耐药,1例患者对头孢曲松耐药。9例患者经抗感染、胸腔闭式引流术、营养支持等对症治疗后好转。结论SA致脓胸患者好发于伴基础疾病的老年人,潜伏期短,住院时间长,感染指标高,存在营养不良,对红霉素和克林霉素耐药率高。

Objective To investigate the clinical characteristics of empyema caused by Streptococcus anginosus(SA).Methods The clinical data in 9 cases of SA caused empyema admitted and treated in the First Affiliated Hospital of Xi’an Medical University from January 2016 to September 2023 were analyzed retrospectively,summarized the clinical characteristics of empyema caused by SA.Results Among 9 patients,there were 8 males and 1 female,with a mean age of(60.8±12.8)years old.All patients had the underlying diseases,meanwhile were accompanied by fever,expectoration,chest pain and dyspnea.The onset time was(6.1±2.2)d.The hospitalization time was(19.33±7.48)d.All patients showed the increase in white blood cells(WBC),C reactive protein(CRP),procalcitonin(PCT),D-dimer(D-D)and pleural effusion lactic dehydrogenase(LDH),and decrease in blood albumin(ALB)and pleural effusion glucose(GLU).Most of the patients had elevation of adenosine deaminase(ADA)in pleural fluid.Four patients had respiratory failure.The drug sensitivity test results of pleural effusion culture suggested five patients were resistant to erythromycin and clindamycin.One patient was resistant to ceftriaxone.Nine patients were improved after symptomatic treatment such as anti-infection,closed thoracic drainage and nutritional support.Conclusion The patients with SA caused empyema are more common in elderly patients with underlying diseases.The incubation period is short,the hospital stay is long,the infection indexes are high,malnutrition exists,and the resistance rate to erythromycin and clindamycin is high.