Capdevila O, Grau I, Vadillo M, Cisnal M, Pallares R
Clinical Research Unit, Hospital de Bellvitge and University of Barcelona, Feixa Llarga s/n, 08907 L' Hospitalet, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2003 Jun;22(6):337-41. doi: 10.1007/s10096-003-0945-z. Epub 2003 Jun 3.
In order to better characterize bacteremic cellulitis caused by Streptococcus pneumoniae, a review was conducted of 10 cases of bacteremic pneumococcal cellulitis, which represented 0.9% of all cases of pneumococcal bacteremia (n=1,076) and 3.2% of all cases of community-acquired bacteremic cellulitis (n=312) that occurred in the Hospital de Bellvitge, Barcelona, from 1984 to 2001. In addition to these 10 cases, 28 cases of bacteremic pneumococcal cellulitis from the literature (Medline 1975-2001) were reviewed. Pneumococcal cellulitis of the face, neck, and trunk was observed more frequently in patients with systemic lupus erythematosus and hematologic disorders, while pneumococcal cellulitis of the limbs was more common in patients with diabetes, alcoholism, and parenteral drug use. In the Hospital de Bellvitge group, bacteremic cellulitis due to Streptococcus pneumoniae was more frequently associated with severe underlying diseases than that due to Staphylococcus aureus or Streptococcus pyogenes (100%, 57%, and 72%, respectively;P=0.01). A concomitant extracutaneous focus of infection (e.g., respiratory tract infection) suggesting hematogenous spread with metastatic cellulitis was more frequent in patients with pneumococcal cellulitis, while a local cutaneous entry of microorganisms was feasible in most patients with Staphylococcus aureus or Streptococcus pyogenes cellulitis. The 30-day mortality was 10% in patients with pneumococcal cellulitis, 13% in patients with Staphylococcus aureus cellulitis, and 23% in patients with Streptococcus pyogenes cellulitis (P=0.3). Thus, bacteremic pneumococcal cellulitis is an unusual manifestation of pneumococcal disease and occurs mainly in patients with severe underlying diseases. In most cases, pneumococcal cellulitis has a different pathophysiologic mechanism than cellulitis caused by Staphylococcus aureus or Streptococcus pyogenes.
为了更好地描述由肺炎链球菌引起的菌血症性蜂窝织炎，我们对10例菌血症性肺炎球菌蜂窝织炎病例进行了回顾性研究，这些病例占巴塞罗那贝尔维特医院1984年至2001年间所有肺炎球菌菌血症病例（n = 1076）的0.9%，以及所有社区获得性菌血症性蜂窝织炎病例（n = 312）的3.2%。除了这10例病例外，我们还回顾了文献（Medline 1975 - 2001）中28例菌血症性肺炎球菌蜂窝织炎病例。面部、颈部和躯干的肺炎球菌蜂窝织炎在系统性红斑狼疮和血液系统疾病患者中更为常见，而肢体的肺炎球菌蜂窝织炎在糖尿病、酗酒和静脉药物使用者中更为常见。在贝尔维特医院组中，肺炎链球菌引起的菌血症性蜂窝织炎比金黄色葡萄球菌或化脓性链球菌引起的菌血症性蜂窝织炎更常与严重的基础疾病相关（分别为100%、57%和72%；P = 0.01）。提示血行播散伴转移性蜂窝织炎的并发皮肤外感染灶（如呼吸道感染）在肺炎球菌蜂窝织炎患者中更为常见，而大多数金黄色葡萄球菌或化脓性链球菌蜂窝织炎患者存在微生物的局部皮肤入侵。肺炎球菌蜂窝织炎患者的30天死亡率为10%，金黄色葡萄球菌蜂窝织炎患者为13%，化脓性链球菌蜂窝织炎患者为23%（P = 0.3）。因此，菌血症性肺炎球菌蜂窝织炎是肺炎球菌疾病的一种不常见表现，主要发生在患有严重基础疾病的患者中。在大多数情况下，肺炎球菌蜂窝织炎的病理生理机制与金黄色葡萄球菌或化脓性链球菌引起的蜂窝织炎不同。
