成人B群链球菌血流感染临床及实验室检查分析

摘要：目的 通过对B群链球菌引起的临床感染，特别是非妊娠成人B群链球菌血流感染的临床、实验室检验指标以及药敏结果进行分析，为临床诊治提供一定依据。方法 回顾收集2012年1月至2018年12月四川大学华西医院临床分离的B群链球菌菌株信息，筛选血培养阳性同时临床诊断为血流感染的患者信息，分析临床和实验室数据结果。结果 276株非重复株B群链球菌分离自男性比例略高于女性，占52.5%，患者平均年龄为(49.2±19.8)岁，分离标本前3位分别是尿液(43.5%)、皮肤软组织及伤口分泌物(25.4%)和血液(10.5%)。22例确诊血流感染患者中，男性患者比例更高占86.4%，平均年龄为(50.8±17.5)岁，所有血流感染患者均有基础疾病，肝胆相关疾病及肿瘤分别占36.4%，泌尿生殖系统疾病占22.7%，合并感染性心内膜炎占13.6%。典型临床表型为发热。血流感染经治疗患者中19例好转出院，2例死亡，1例自动出院。B群链球菌血流感染常规炎性指标与其他链球菌血流感染数据相比无特异性。血流感染分离菌株对克林霉素和左氧氟沙星耐药率较高分别为79.2%和45.5%，对青霉素、氨苄西林、万古霉素和利奈唑胺未发现耐药株。结论 成人B群链球菌血流感染者主要为中年男性，多合并有基础疾病，临床及实验室检查无特异性，对于发热患者应尽早规范采集血培养以明确诊断，青霉素是B群链球菌感染的首选治疗药物，保持着较高的敏感性，克林霉素以及左氧氟沙星耐药率较高，不推荐经验使用，临床治疗时应重视药敏结果，避免不合理用药。B群链球菌血流感染者经临床合理诊治预后较好。

Analysis of clinical and laboratory data of adult group B streptococcal bloodstream infections

bstract Objective The clinical features and laboratory data of infections caused by group B Streptococcus in non-pregnant adults were analyzed to provide a reference for clinical diagnosis and treatment. Methods The data of group B Streptococcus were collected from West China Hospital of Sichuan University between January 2012 to December 2018, the information of patients with bloodstream infections was screened, and clinical and laboratory data results were analyzed. Results The proportion of 276 non-repeated group B streptococci in men was slightly higher than that in women, accounting for 52.5%. The average age was (49.2±19.8) years. Among the strain of group B Streptococcus, 43.5% strains were isolated from urine, 25.4% strains were isolated from skin soft tissue and wound secretions, and 10.5% strains were isolated from blood. Among the 22 patients with bloodstream infections, a higher proportion of male patients accounted for 86.4%, with an average age of (50.8±17.5) years. All patients with bloodstream infections had underlying diseases, hepatobiliary related diseases and tumors accounted for 36.4%, urogenital diseases accounted for 22.7%, and complicated infective endocarditis accounted for 13.6%. Typical clinical phenotype was fever. The conditions of nineteen patients improved and they were discharged, two died, and one abandoned treatment. The blood routine and inflammatory indexes of group B streptococcal bloodstream infections were not specific compared with other streptococcal bloodstream infections. The isolated strains of bloodstream infections had higher resistance rates to clindamycin and levofloxacin, which were 79.2% and 45.5%, respectively. No resistant strains were found to penicillin, ampicillin, vancomycin, and linezolid. Conclusion Adults with group B streptococcal bloodstream infections are mainly middle-aged men, most of them with underlying diseases. Clinical and laboratory data are not specific. For patients with fever, blood culture should be performed as soon as possible to detect the pathogen. Penicillin is the first choice for the treatment of group B streptococcal infections. Clindamycin and levofloxacin have high resistance rates and are not recommended to the experience therapy. Antimicrobial susceptibility results are important in clinical treatment to avoid unreasonable medication. Group B streptococcal bloodstream infections should have a good prognosis with reasonable clinical diagnosis and treatment.