Zimbelman J, Palmer A, Todd J
Department of Pediatrics, The University of Colorado School of Medicine, Denver, USA.
Pediatr Infect Dis J. 1999 Dec;18(12):1096-100. doi: 10.1097/00006454-199912000-00014.
Animal model studies have demonstrated the failure of penicillin to cure Streptococcus pyogenes myositis and have suggested that clindamycin is a more effective treatment.
To determine the most effective antibiotic treatment for invasive S. pyogenes infection in humans.
We conducted a retrospective review of the outcomes of all inpatients from 1983 to 1997 treated for invasive S. pyogenes infection at Children's Hospital.
Fifty-six children were included, 37 with initially superficial disease and 19 with deep or multiple tissue infections.
Lack of progression of disease (or improvement) after at least 24 h of treatment.
The median number of antibiotic exposures was 3 per patient (range 1 to 6) with clindamycin predominating in 39 of 45 courses of protein synthesis-inhibiting antibiotics and beta-lactams predominating amongst the cell wall-inhibiting antibiotics in 123 of 126 of the remainder. Clindamycin was often used in combination with a beta-lactam antibiotic. Overall there was a 68% failure rate of cell wall-inhibiting antibiotics when used alone. Patients with deep infection were more likely to have a favorable outcome if initial treatment included a protein synthesis-inhibiting antibiotic as compared with exclusive treatment with cell wall-inhibiting antibiotics (83% vs. 14%, P = 0.006) with a similar trend in those with superficial disease (83% vs. 48%, P = 0.07). For those children initially treated with cell wall-inhibiting antibiotics alone, surgical drainage or debridement increased the probability of favorable outcome in patients with superficial disease (100% vs. 41%, P = 0.04) with a similar trend in a smaller number of deep infections (100% vs. 0%, P = 0.14).
This retrospective study suggests that clindamycin in combination with a beta-lactam antibiotic (with surgery if indicated) might be the most effective treatment for invasive S. pyogenes infection.
动物模型研究表明青霉素无法治愈化脓性链球菌肌炎，并提示克林霉素是更有效的治疗药物。
确定人类侵袭性化脓性链球菌感染最有效的抗生素治疗方案。
我们对1983年至1997年在儿童医院接受侵袭性化脓性链球菌感染治疗的所有住院患者的治疗结果进行了回顾性研究。
纳入56名儿童，37名最初为浅表疾病，19名患有深部或多处组织感染。
治疗至少24小时后疾病无进展（或改善）。
每位患者抗生素暴露的中位数为3次（范围1至6次），在45个蛋白质合成抑制性抗生素疗程中，39个以克林霉素为主，其余126个细胞壁抑制性抗生素疗程中，123个以β-内酰胺类为主。克林霉素常与β-内酰胺类抗生素联合使用。总体而言，单独使用细胞壁抑制性抗生素时，失败率为68%。与仅使用细胞壁抑制性抗生素相比，如果初始治疗包括蛋白质合成抑制性抗生素，深部感染患者更有可能获得良好结局（83%对14%，P = 0.006），浅表疾病患者也有类似趋势（83%对48%，P = 0.07）。对于那些最初仅接受细胞壁抑制性抗生素治疗的儿童，手术引流或清创术增加了浅表疾病患者获得良好结局的可能性（100%对41%，P = 0.04），在数量较少的深部感染患者中也有类似趋势（100%对0%，P = 0.14）。
这项回顾性研究表明，克林霉素联合β-内酰胺类抗生素（必要时进行手术）可能是侵袭性化脓性链球菌感染最有效的治疗方法。
