Empyema thoracis and lung abscess caused by viridans streptococci
Empyema thoracis and lung abscess caused by viridans streptococci
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DOI：
10.1164/ajrccm.156.5.97-03006
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发表时间：
1997-11-01
影响因子：
24.7
通讯作者：
Luh, KT
中科院分区：
文献类型：
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作者：
Jerng, JS;Hsueh, PR;Luh, KT
我们回顾性分析了1984年1月至1996年9月收治的72例由绿绿链球菌引起的胸脓肿和肺脓肿的细菌学及临床特点。共分离出76株绿绿链球菌，其中最常见的是星座链球菌（21株）、中间链球菌（17株）和血链球菌（10株）。属5，milleri类群的种占大多数（68%）。在38例（53%）患者中，这些微生物被认为是唯一的病原体。72例患者中，53例有脓肿，14例有肺脓肿，5例既有脓肿又有肺脓肿。46例（64%）患者有基础疾病。其中，恶性肿瘤最常见（17例），其次是糖尿病（12例）和中枢神经系统疾病（10例）。48例胸管引流患者中，27例（56%）接受了进一步治疗，包括胸膜内链激酶（18例）、手术（9例）、胸膜内链激酶和手术（3例）。2例（14%）单独肺脓肿患者接受手术治疗。尽管所有的绿绿链球菌分离株都对青霉素敏感，但研究中的患者死亡率很高（21%）。单因素和多因素数据分析显示，单纯脓胸患者（n = 53）的潜在恶性肿瘤患者（OR = 16.0, p = 0.023）和非脓胸患者的死亡风险显著增加。米勒氏菌群分离株（OR = 3.72, p = 0.030）。这些数据提示翠绿链球菌在脓气肿和肺脓肿的发病机制中具有很强的临床意义，同时也提示胸膜肺疾病患者需要对翠绿链球菌进行菌种鉴定。
We retrospectively studied the bacteriology and clinical features of empyema thoracis and lung abscess caused by viridans streptococci in 72 patients seen from January 1984 to September 1996. A total of 76 strains of viridans streptococci were isolated, of which the most common isolates were Streptococcus constellatus (21 strains), S. intermedius (17), and S. sanguis (10). Species belonging to the 5, milleri group accounted for the majority (68%) of isolates. In 38 (53%) patients these organisms were recognized as the sole pathogens. Of the 72 patients, 53 had empyema, 14 had lung abscesses, and five had both empyema and lung abscess. Forty-six (64%) patients had underlying diseases. Of these, malignancies were the most common (17 patients), followed by diabetes mellitus (12 patients) and central nervous system diseases (10 patients). Of the 48 patients who underwent chest-tube drainage, 27 (56%) received further treatments, including intrapleural streptokinase (18 cases), surgery (9), and both intrapleural streptokinase and surgery (3). Two (14%) of the patients with lung abscess alone underwent surgical treatment. Although all viridans streptococcal isolates were susceptible to penicillin, the patients in the study had a high mortality (21%). Univariate and multivariate analysis of data for patients with empyema alone (n = 53) showed a significantly increased risk of death in those with underlying malignancy (OR = 16.0, p = 0.023) and those with non-S. milleri-group isolates (OR = 3.72, p = 0.030). These data imply a strong clinical significance of viridans streptococci in the pathogenesis of empyema and lung abscess, as well as the need for species identification of viridans streptococci in patients with pleuropulmonary diseases.