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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (2): 125-130.

• 论著 • 上一篇    下一篇

咽峡炎链球菌群感染患儿119例病例系列报告

胡惠丽1，董方2，宁雪1，谢悦1，郭欣1，郭凌云1，刘钢1   

  1. 首都医科大学附属北京儿童医院 北京，100045；1 感染内科，2 检验科
  • 收稿日期:2019-07-23 修回日期:2019-08-20 出版日期:2020-04-25 发布日期:2020-04-25
  • 通讯作者: 刘钢

Streptococcus anginosus group infectionin 119 children: A case series report

HU Hui-li1, DONG Fang2, NING Xue1, XIE Yue1, GUO Xin1, GUO Ling-yun1, LIU Gang1   

  1. Beijing Children's Hospital, Capital Medical University, Beijing 100045, China；1 Infectious Diseases Department, 2 Clinical Laboratory
  • Received:2019-07-23 Revised:2019-08-20 Online:2020-04-25 Published:2020-04-25
  • Contact: LIU Gang

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摘要： 目的 探讨咽峡炎链球菌群（SAG）感染患儿的临床特征。方法 回顾性收集2012年1月1日至2019年12月31日首都医科大学附属北京儿童医院细菌培养SAG阳性病例；结合其微生物学、放射学和临床资料对每一分离株进行详细评估，排除SAG阳性为污染和定植菌株。采集病例资料中的发病年龄、性别、临床表现、辅助检查、治疗、转归及预后，菌种鉴定结果及药敏试验。根据病史分为有、无基础疾病2组。基础疾病主要包括先天性心脏病、梨状窝瘘、皮毛窦、先天性食管瘘、先天性胆总管囊肿等先天畸形，免疫抑制，副鼻窦炎，脑性瘫痪，食管异物等。结果 119例感染SAG患儿年龄33 d至16岁，中位年龄4岁（5）；有基础疾病组56例（47.1%），主要包括头颈部感染27例(48.2%)，中枢神经系统感染11例（19.6%）和血流感染10例（17.9%）；头颈部感染中梨状窝瘘19/27例（70.4%）；血流感染中免疫抑制6/10例（60.0%）；中枢神经系统感染中先天性心脏病7/11例（63.6%），以中间链球菌为主。有、无基础疾病SAG感染患儿，住院天数、热程、外周血WBC计数、中性粒细胞百分比、CRP和血沉差异均无统计学意义。104例(93.7%) SAG感染患儿形成脓肿，头颈部感染41.2%，其次为腹腔感染20.2%、中枢神经系统感染12.6%、血流感染12.6%；咽峡炎链球菌44株，星座链球菌41株，中间链球菌34株。对青霉素、氨苄西林、头孢噻肟、红霉素、克林霉素、万古霉素和利奈唑胺的敏感性分别为87.4%、93.2%、94.2%、20.2%、21.8%、100%和100%。死亡1例，2例因病情危重放弃治疗。结论 SAG感染常形成脓肿，头颈部感染最多见，有、无基础疾病的SAG感染患儿临床特征差异并不明显，中间链球菌是导致脑脓肿的主要SAG病原，SAG菌株对青霉素类抗生素敏感，对大环内酯类抗生素耐药。

Abstract: Objective To investigate the clinical characteristics of children infected by Streptococcus anginosus group. Methods From January 1, 2012 to December 31, 2019, cases positive for Streptococcus anginosus group in bacterial culture in Beijing Children's Hospital were collected retrospectively. Combined with their microbiology, radiology and clinical data, each isolated strain was evaluated in detail to exclude the positive cases caused by contamination and colonization strains. Age of onset, gender, clinical manifestations, laboratory tests, treatment, outcome and prognosis of the cases were analyzed and the bacterial identification and drug sensitivity test were conducted. According to the medical history, the patients were divided into two groups with or without underlying diseases. Underlying diseases referred to congenital heart disease, pyriform sinus fistula, dermal sinus, congenital esophageal fistula, congenital choledochal cyst and other congenital malformations, immunosuppression, paranasal sinusitis, cerebral palsy, esophageal foreign bodies, etc. Results A total of 119 cases were at the age of 33 days to 16 years, with a median age of 4 years. There were 56 (47.1%) in underlying disease group including 27 (48.2%) with head and neck infection, 11 (19.6%) with central nervous system (CNS) infection and 10 (17.9%) with bloodstream infection (BSI). Of head and neck infection, 70.4% (19/27) was pyriform sinus fistula; of BSI, 60.0% (6/10) was immunodepression; of CNS infection, 63.6% (7/11) was congenital heart disease. There were no significant differences in the average hospitalization days, average fever duration, WBC count, neutrophil percentage, CRP and ESR between the two groups. One hundred and four (93.7%) children infected by Streptococcus anginosus group had abscess with head and neck infection, abdominal infection, CNS infection, BSI accounting for 41.2%, 20.2%, 12.6% and 12.6% respectively. For strain identification, there were 44 cases of Streptococcus anginosus, 41 cases of Streptococcus constellatus and 34 cases of Streptococcus intermedius. The sensitivity to penicillin, ampicillin, cefotaxime, erythromycin, clindamycin and vancomycin was 87.4%, 93.2%, 94.2%, 20.2%, 21.8%, 100% and 100%, respectively. One case died and 2 cases gave up the treatment because of critical illness. Conclusion Streptococcus anginosus group infection could result in abscesses. Head and neck infection was the most common. There were no significant differences in the clinical characteristics of Streptococcus anginosus group infection in children with and without underlying diseases. Streptococcus intermedius was the main cause of brain abscess. Most of Streptococcus anginosus group strains were sensitive to penicillin antibiotics but resistant to macrolides.