Diversity of Group B Streptococcus Serotypes Causing Urinary Tract Infection in Adults
Diversity of Group B Streptococcus Serotypes Causing Urinary Tract Infection in Adults
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DOI：
10.1128/jcm.00154-09
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发表时间：
2009-07-01
影响因子：
9.4
通讯作者：
Ulett, Glen C.
中科院分区：
文献类型：
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作者：
Ulett, Kimberly B.;Benjamin, William H., Jr.;Ulett, Glen C.
引起尿路感染（UTI）的B组链球菌（GBS）的血清型的特征很差。我们在成年人中对GBS UTI进行了前瞻性研究，以定义这些感染的临床和微生物学特征，包括哪些血清型引起疾病。根据症状，细菌和尿液分析，在1年内从尿液中培养的GB的患者分组。人口统计数据是通过审查医疗记录获得的。通过乳胶凝集和多重PCR逆线印迹（MPCR/RLB）将分离株通过血清元素分型。通过椎间盘扩散确定抗生素敏感性。从连续387/34,367次尿液样本（1.1％）中培养GBS：62例患者的细菌尿症> 10（7）CFU/升和至少一种UTI症状；在这些患者中，有31例患有尿白细胞酯酶和脓尿（其他未测试），有50（81％）的症状与膀胱炎一致，而12例（19％）患有肾盂肾炎症状。与对照组（将GBS隔离而没有症状）相比，先前的UTI病史是疾病的独立危险因素。年龄增加也与急性感染显着相关。在331/387（85.5％）分离株中，乳胶凝集和MPCR/RLB之间的血清分型结果是一致的。 22（5.7％）和7（1.8％）分离株与抗血清和MPCR/RLB分别不可用；和45/56（80.4％）具有差异结果的分离株由MPCR/RLB键入属于血清型V。血清型V，IA和III导致最多的UTI。血清型II，IB和IV不太常见。不可用的GB与UTI无关。红霉素（39.5％）和克林霉素（26.4％）耐药很常见。我们得出的结论是，除了不可用的GB外，多种多样的GBS血清型会引起UTI。
Serotypes of group B streptococcus (GBS) that cause urinary tract infection (UTI) are poorly characterized. We conducted a prospective study of GBS UTI in adults to define the clinical and microbiological characteristics of these infections, including which serotypes cause disease. Patients who had GBS cultured from urine over a 1-year period were grouped according to symptoms, bacteriuria, and urinalysis. Demographic data were obtained by reviewing medical records. Isolates were serotyped by latex agglutination and multiplex PCR-reverse line blotting (mPCR/RLB). Antibiotic susceptibilities were determined by disc diffusion. GBS was cultured from 387/34,367 consecutive urine samples (1.1%): 62 patients had bacteriuria of > 10(7) CFU/liter and at least one UTI symptom; of these patients, 31 had urinary leukocyte esterase and pyuria (others not tested), 50 (81%) had symptoms consistent with cystitis, and 12 (19%) had symptoms of pyelonephritis. Compared with controls (who had GBS isolated without symptoms), a prior history of UTI was an independent risk factor for disease. Increased age was also significantly associated with acute infection. Serotyping results were consistent between latex agglutination and mPCR/RLB for 331/387 (85.5%) isolates; 22 (5.7%) and 7 (1.8%) isolates were nontypeable with antisera and by mPCR/RLB, respectively; and 45/56 (80.4%) isolates with discrepant results were typed by mPCR/RLB as belonging to serotype V. Serotypes V, Ia, and III caused the most UTIs; serotypes II, Ib, and IV were less common. Nontypeable GBS was not associated with UTI. Erythromycin (39.5%) and clindamycin (26.4%) resistance was common. We conclude that a more diverse spectrum of GBS serotypes causes UTI than previously recognized, with the exception of nontypeable GBS.