Clinical and Molecular Characteristics of Invasive and Noninvasive Skin and Soft Tissue Infections Caused by Group A Streptococcus
Clinical and Molecular Characteristics of Invasive and Noninvasive Skin and Soft Tissue Infections Caused by Group A Streptococcus
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DOI：
10.1128/jcm.00531-11
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发表时间：
2011-10-01
影响因子：
9.4
通讯作者：
Chen, Yen-Hsu
中科院分区：
文献类型：
--
作者：
Lin, Jiun-Nong;Chang, Lin-Li;Chen, Yen-Hsu
由A组链球菌（GAS）引起的皮肤和软组织感染的严重程度是可变的，文献中只有有限数量的研究评估这些感染的特征。2005年5月至2007年11月，73例A组链球菌引起的皮肤和软组织感染患者纳入本研究。其中34例（46.6%）有浸润性疾病。糖尿病、酗酒和高血压是最常见的基础疾病。总死亡率为6.8%，老年人易发生侵袭性感染（P < 0.001）。中性粒细胞百分比>= 80，血清肌酐水平>= 2 mg/dl，高血清C反应蛋白水平在侵袭性感染患者中比非侵袭性感染患者更常见，菌血症和高死亡率也是如此。在73株分离株中，红霉素、克林霉素和四环素的敏感率分别为93.2%、97.3%和37%。最常见的5种emm类型是emm 106（24.7%）、emm 11（12.3%）、emm 102（9.6%）、emm 4（8.2%）和emm 12（8.2%）。与其他类型相比，emm 106型更容易与浸润性疾病相关（P = 0.012）。树状图分析显示emm 106型的独特的SmaI消化脉冲场凝胶电泳模式，其特别易于引起侵袭性皮肤和软组织感染（P < 0.001）。这项研究的结果表明，分离与emm 106基因可能是一个新兴的A组链球菌菌株，导致侵入性皮肤和软组织感染。进一步监测研究以了解这种侵袭性菌株的重要性至关重要。
The severity of skin and soft tissue infections caused by group A Streptococcus (GAS) is variable, and there are only a limited number of studies evaluating the characteristics of these infections in the literature. From May 2005 to November 2007, 73 patients with skin and soft tissue infections caused by group A Streptococcus were included in this study. Among these patients, 34 (46.6%) had invasive diseases. Diabetes mellitus, alcoholism, and hypertension were the most common underlying disorders. The overall mortality rate was 6.8%, and the elderly were predisposed to invasive infections (P < 0.001). Neutrophil percentages of >= 80, serum creatinine levels of >= 2 mg/dl, and high serum C-reactive protein levels were noted more frequently in patients with invasive infections than in patients with noninvasive infections, as were bacteremia and a high mortality rate. Of the 73 isolates, 93.2%, 97.3%, and 37% exhibited susceptibility to erythromycin, clindamycin, and tetracycline, respectively. The five most prevalent emm types were emm106 (24.7%), emm11 (12.3%), emm102 (9.6%), emm4 (8.2%), and emm12 (8.2%). Compared to other types, the emm106 type was significantly more likely to be associated with invasive diseases (P = 0.012). Dendrogram analysis showed a unique SmaI-digested pulsed-field gel electrophoresis pattern of the emm106 type that was particularly prone to cause invasive skin and soft tissue infections (P < 0.001). The results of this study suggest that isolates with the emm106 gene may be an emerging group A Streptococcus strain that causes invasive skin and soft tissue infections. Further surveillance study to understand the significance of this invasive strain is critical.