咽峡炎链球菌群肺脓肿患者的临床特征及其耐药分析  

Clinical characteristics and drug resistance of Streptococcus anginosus group pulmonary abscess in patients

作　　者：侯轩 何小亮 蒋琰 伍雪晴 张微 王辉[1] 陶浚齐 邓明惠 周梦蓉 辜依海 HOU Xuan;HE Xiaoliang;JIANG Yan;WU Xueqing;ZHANG Wei;WANG Hui;TAO Junqi;DENG Minghui;ZHOU Mengrong;GU Yihai(Department of Microbiology and Immunology,3201 Hospital,Xi’an Jiaotong University Health Science Center,Hanzhong 723000,China;Department of Laboratory Medicine,Hanzhong Central Hospital,Hanzhong 723000,China;Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province,Hangzhou 310018,China;Department of Infectious Diseases,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310018,China)

机构地区：[1]西安交通大学医学部附属三二〇一医院微生物免疫科,陕西汉中723000 [2]汉中市中心医院检验科,陕西汉中723000 [3]浙江省微生物技术与生物信息学重点实验室,浙江杭州310018 [4]浙江大学邵逸夫医院医学院感染性疾病科,浙江杭州310018

出　　处：《中国感染控制杂志》2025年第2期207-213,共7页Chinese Journal of Infection Control

基　　金：陕西省重点研发计划项目(2024SF-YBXM-279)。

摘　　要：目的了解咽峡炎链球菌群(SAG)肺脓肿患者的临床特征及SAG耐药特点。方法回顾性分析2018年1月—2022年5月某院收治的67例肺脓肿患者,分析SAG肺脓肿患者的临床资料,采用微量肉汤稀释法检测抗菌药物对18株SAG的最低抑菌浓度,采用高通量测序技术检测SAG耐药基因和毒力基因携带情况。结果67例肺脓肿患者,SAG占29.9%(20/67),其中2例因细菌失活被剔除,18例患者纳入进一步研究。18例SAG肺脓肿患者均为社区获得,平均年龄(60.9±9.1)岁,男性13例(72.2%),患者多合并慢性肺部疾病(94.4%),以咳嗽(94.4%)、咳痰(88.9%)为首发症状,部分伴胸痛(44.4%),半数以上不伴发热(61.1%),多数中性粒细胞比例、血沉以及C反应蛋白升高,降钙素原正常。18株SAG对红霉素、克林霉素、四环素的耐药率>65%,其中14株携带耐药基因erm B,13株携带耐药基因tet M,1株同时携带耐药基因msr D和mef A。18株SAG均检出毒力基因psa A,其中3株检出毒力基因nan A。结论SAG是引起肺脓肿的重要病原体,患者合并症以慢性肺部疾病为主,临床表现无特异性;菌株多数携带erm B和tet M基因,介导对大环内酯类、林可酰胺类以及四环素类抗生素耐药。Objective To understand the clinical characteristics of patients with Streptococcus anginosus group(SAG)pulmonary abscess and resistance of SAG.Methods 67 patients with pulmonary abscess admitted to a hospital from January 2018 to May 2022 were retrospectively analyzed,clinical data of patients with SAG pulmonary abscess were analyzed,and the minimum inhibitory concentration of antimicrobial agents to 18 SAG strains was detected by microbroth dilution method,the carriage of resistance genes and virulence genes of SAG were detected by high-throughput sequencing technology.Results Among 67 patients with pulmonary abscess,SAG accounted for 29.9%(20/67),out of which 2 were excluded due to bacterial inactivation,and 18 patients were included for further studies.18 patients with SAG pulmonary abscess were all community acquired,with an average age of(60.9±9.1)years.There were 13(72.2%)male patients,most patients(94.4%)complicated chronic pulmonary disease,with cough(94.4%)and expectoration(88.9%)as the initial symptoms,some patients(44.4%)had chest pain,and more than half(61.1%)didn’t have fever.The proportion of neutrophils,erythrocyte sedimentation rate,and C-reactive protein were mostly elevated,while procalcitonin was normal.The resistance rate of 18 SAG strains to erythromycin,clindamycin,and tetracycline was>65%,out of which 14 strains carried resistance gene erm B,13 strains carried resistance gene tet M,and 1 strain carried both resistance gene msr D and mef A.18 SAG strains were detected virulence gene psa A,out of which 3 strains were detected virulence gene nan A.Conclusion SAG is an important pathogen that causes pulmonary abscess,and the patients’complications are mainly chronic pulmonary di-seases,with non-specific clinical manifestations;Most strains carry erm B and tet M genes,mediating resistance to macrolides,lincosamides,and tetracyclines.

关 键 词：咽峡炎链球菌群 耐药基因 毒力基因 肺脓肿 临床特征 

分 类 号：R181.32[医药卫生—流行病学] R563[医药卫生—公共卫生与预防医学]