Clinical characteristics of 39 cases of Streptococcus dysgalactiae subspecies equisimilis bloodstream infection
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摘要:目的
分析39例停乳链球菌似马亚种（SDSE）血流感染患者的临床特征及诊治经过。
方法回顾性分析39例45人次发作的SDSE血流感染患者一般资料、基础疾病、临床表现、实验室检查、SDSE药物敏感性分析、治疗及转归。
结果39例确诊的SDSE血流感染患者中38例（97.4%）有基础疾病。最常见的基础疾病为恶性肿瘤（17例，46.1%）。SDSE血流感染主要临床表现为发热，以急性高热为主。16人次诊断为丹毒；4人次诊断为皮肤软组织感染；1例诊断为急性下肢静脉炎合并淋巴水肿。有4例次多次（2~3次）确诊为SDSE血流感染。所有患者全部行血培养检查。14例仅行1套血培养检查，31例行2套血培养检查。38份需氧培养结果阳性，40份厌氧培养结果阳性，33份厌氧和需氧培养结果阳性。22例血白细胞升高；中性粒细胞28例升高；3例白细胞及中性粒细胞计数都降低。42人次行药敏试验，对红霉素、克林霉素耐药率分别为90.4%，76.2%。入院时或出现发热后给予经验性抗感染治疗，确诊为SDSE后根据药敏选用药物。最终41人次治愈，4例死亡。
结论SDSE血流感染患者多有基础疾病，患者多表现为发热及丹毒，且易复发。SDSE血流感染首选青霉素抗感染治疗，必要时需联合抗感染治疗。
Abstract:ObjectiveTo analyze clinical characteristics, diagnosis and treatment of 39 patients with blood flow infection of Streptococcus dysgalactiae subspecies equisimilis (SDSE).
MethodsGeneral data, underlying diseases, clinical manifestations, laboratory tests, drug sensitivity analysis, treatment and outcome of SDSE in 39 patients with 45 episodes of SDSE bloodstream infection were retrospectively analyzed.
ResultsOf the 39 patients diagnosed with SDSE bloodstream infection, 38 cases (97.4%) had underlying disease. The common underlying disease was malignancy (17 cases, 46.1%). The main clinical manifestations of SDSE bloodstream infection were fever, mainly acute hyperthermia. A total of 16 person-time were diagnosed as erysipelas; 4 person-time were diagnosed with skin and soft tissue infection, and one case was diagnosed as acute lower extremity phlebitis with lymphedema. Four person-time were diagnosed with repeated SDSE bloodstream infection (2 to 3 times). All patients underwent blood culture examination. Only one set of blood culture test was performed in 14 cases, and 31 patients underwent two sets of blood culture tests. A total of 38 samples were positive for aerobic culture, 40 samples were positive for anaerobic culture, and 33 samples were positive for anaerobic and aerobic culture. Leukocyte elevation occurred in 22 cases; elevated neutrophils in 28 cases; leukocyte and neutrophil counts decreased in 3 cases. Forty-two person-time were tested for erythromycin and clindamycin, and the resistance rates were 90.4% and 76.2%, respectively. Empiric anti-infective therapy was given upon admission or after fever, and drugs were selected according to drug sensitivity test after diagnosis of SDSE. The 41 person-time were cured and 4 cases died.
ConclusionMost patients with SDSE bloodstream infection have underlying diseases, and most patients present fever and erysipelas, which are prone to relapse. The first choice for SDSE bloodstream infection is penicillin anti-infective therapy, combined with anti-infective therapy is needed if necessary.
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表 1 39例(45人次)患者一般临床特点(x±s)[n(%)]
临床特点 分类 比率 年龄 15~39岁 1(2.6) 40~64岁 13(33.3) ≥65岁 25(64.1) 平均年龄/岁 70.6±15.6 性别 男 25(64.1) 女 14(35.9) 基础疾病史 恶性肿瘤史 17(43.6) 宫颈癌或子宫内膜手术史 10(25.6) 放疗史 9(23.1) 高血压 10(25.6) 心脏疾病 6(15.4) 糖尿病 5(12.8) 肝硬化 3(7.7) 肾功能不全 3(7.7) 心脏病手术史 3(7.7) 社区感染 38(84.5) 临床结局 治愈 41(91.1) 死亡 4(8.9) 社区感染、临床结局均以45人次进行计算。 
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表 2 复发性SDSE血流感染的部分临床特点
次 序例 基础疾病 因发热住院次数 培养阳性次数 1 子宫内膜癌术后及放疗后 5 3 2 宫颈癌术后及放疗后 3 3 3 宫颈癌术后及放疗后 2 2 4 心脏瓣膜病 2 2
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