Department of Clinical Science, University of Bergen; Departments of Medicine.
Department of Clinical Science, University of Bergen; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
Open Forum Infect Dis. 2015 Nov 25;3(1):ofv181. doi: 10.1093/ofid/ofv181. eCollection 2016 Jan.
Background. The importance of bacteria other than group A streptococci (GAS) in different clinical presentations of cellulitis is unclear, commonly leading to treatment with broad-spectrum antibiotics. The aim of this study was to describe the etiological and clinical spectrum of cellulitis and identify clinical features predicting streptococcal etiology. Methods. We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical details were registered. Bacterial culture was performed from blood, cutaneous or subcutaneous tissue, and/or swabs from skin lesions. Paired serum samples were analyzed for anti-streptolysin O and anti-deoxyribonuclease B antibodies. Results. Serology or blood or tissue culture confirmed β-hemolytic streptococcal (BHS) etiology in 72% (146 of 203) of cases. An additional 13% (27 of 203) of cases had probable BHS infection, indicated by penicillin response or BHS cultured from skin swabs. β-hemolytic streptococcal etiology was predominant in all clinical subgroups, including patients without sharply demarcated erythema. β-hemolytic group C or G streptococci (GCS/GGS) were more commonly isolated than GAS (36 vs 22 cases). This predominance was found in the lower extremity infections. Group C or G streptococci in swabs were associated with seropositivity just as often as GAS. Staphylococcus aureus was cultured from swabs as a single pathogen in 24 cases, 14 (64%) of which had confirmed BHS etiology. Individual BHS-associated clinical characteristics increased the likelihood of confirmed BHS disease only slightly; positive likelihood ratios did not exceed 2.1. Conclusions. β-hemolytic streptococci were the dominating cause of cellulitis in all clinical subgroups and among cases with S aureus in cutaneous swabs. Group C or G streptococci were more frequently detected than GAS. No single clinical feature substantially increased the probability of confirmed BHS etiology.
除 A 组链球菌（GAS）以外的细菌在不同临床表现的蜂窝织炎中的重要性尚不清楚，通常导致使用广谱抗生素进行治疗。本研究的目的是描述蜂窝织炎的病因学和临床谱，并确定预测链球菌病因学的临床特征。
我们前瞻性地招募了 216 名因蜂窝织炎住院的患者。记录了临床详细信息。从血液、皮肤或皮下组织以及/或皮肤病变的拭子中进行细菌培养。分析配对血清样本以检测抗链球菌溶血素 O 和抗脱氧核糖核酸酶 B 抗体。
血清学或血液或组织培养证实β-溶血性链球菌（BHS）病因在 72%（203 例中的 146 例）的病例中。另外 13%（203 例中的 27 例）的病例可能存在 BHS 感染，表现为青霉素反应或从皮肤拭子中培养出 BHS。在所有临床亚组中，包括红斑边界不清的患者，β-溶血性链球菌病因均占主导地位。β-溶血性 C 或 G 链球菌（GCS/GGS）比 GAS 更常被分离（36 例与 22 例）。这种优势在下肢感染中更为明显。拭子中分离出 C 或 G 链球菌与 GAS 一样常与血清阳性相关。24 例拭子中仅培养出金黄色葡萄球菌作为单一病原体，其中 14 例（64%）有明确的 BHS 病因。单个 BHS 相关的临床特征仅略微增加了确诊 BHS 疾病的可能性；阳性似然比未超过 2.1。
β-溶血性链球菌是所有临床亚组和皮肤拭子中金黄色葡萄球菌存在的蜂窝织炎的主要原因。C 或 G 链球菌比 GAS 更常被检测到。没有单个临床特征能显著增加确诊 BHS 病因的概率。
