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

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ermB,13株携带耐药基因tetM,1株同时携带耐药基因msrD和mefA。18株SAG均检出毒力基因psaA,其中3株检出毒力基因nanA。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ermB和tetM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。

Abstract:

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 ermB, 13 strains carried resistance gene tetM, and 1 strain carried both resistance gene msrD and mefA. 18 SAG strains were detected virulence gene psaA, out of which 3 strains were detected virulence gene nanA. 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 ermB and tetM genes, mediating resistance to macrolides, lincosamides, and tetracyclines.