Pimentel B A S, Martins C A S, Mendonça J C, Miranda P S D, Sanches G F, Mattos-Guaraldi A L, Nagao P E
Roberto Alcântara Biology Institute, Rio de Janeiro State University - UERJ, Rio de Janeiro, RJ-LBMFE/IBRAG, Rua São Francisco Xavier, 524 - PHLC 5º andar sala 501B- Maracanã, 20550-013, Rio de Janeiro, RJ, Brazil.
National Cancer Institute - INCA, Rio de Janeiro, RJ-HICC/HC1, Rio de Janeiro, Brazil.
Eur J Clin Microbiol Infect Dis. 2016 Jun;35(6):927-33. doi: 10.1007/s10096-016-2617-9. Epub 2016 Mar 18.
Although the highest burden of Streptococcus agalactiae infections has been reported in industrialized countries, studies on the characterization and epidemiology are still limited in developing countries and implementation of control strategies remains undefined. The aim of this retrospective study was to assess the epidemiological, clinical, and microbiological aspects of S. agalactiae infections in cancer patients treated at a Reference Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil. We reviewed the clinical and laboratory records of all cancer patients identified as having invasive S. agalactiae disease during 2010-2014. The isolates were identified by biochemical analysis and tested for antimicrobial susceptibility. A total of 263 strains of S. agalactiae were isolated from cancer patients who had been clinically and microbiologically classified as infected. S. agalactiae infections were mostly detected among adults with solid tumors (94 %) and/or patients who have used indwelling medical devices (77.2 %) or submitted to surgical procedures (71.5 %). Mortality rates (in-hospital mortality during 30 days after the identification of S. agalactiae) related to invasive S. agalactiae infections (n = 28; 31.1 %) for the specific category of neoplasic diseases were: gastrointestinal (46 %), head and neck (25 %), lung (11 %), hematologic (11 %), gynecologic (4 %), and genitourinary (3 %). We also found an increase in S. agalactiae resistance to erythromycin and clindamycin and the emergence of penicillin-less susceptible isolates. A remarkable number of cases of invasive infections due to S. agalactiae strains was identified, mostly in adult patients. Our findings reinforce the need for S. agalactiae control measures in Brazil, including cancer patients.
尽管工业化国家报告的无乳链球菌感染负担最高，但发展中国家对其特征和流行病学的研究仍然有限，控制策略的实施也尚不明确。这项回顾性研究的目的是评估在巴西里约热内卢的巴西国家癌症研究所（INCA）接受治疗的癌症患者中无乳链球菌感染的流行病学、临床和微生物学方面的情况。我们回顾了2010年至2014年期间所有被确定患有侵袭性无乳链球菌病的癌症患者的临床和实验室记录。通过生化分析鉴定分离株，并检测其抗菌药敏性。从临床和微生物学分类为感染的癌症患者中总共分离出263株无乳链球菌。无乳链球菌感染大多在患有实体瘤的成年人（94%）和/或使用过留置医疗设备的患者（77.2%）或接受过外科手术的患者（71.5%）中被检测到。与侵袭性无乳链球菌感染（n = 28；31.1%）相关的特定肿瘤疾病类别的死亡率（无乳链球菌鉴定后30天内的院内死亡率）为：胃肠道（46%）、头颈（25%）、肺部（11%）、血液学（11%）、妇科（4%）和泌尿生殖系统（3%）。我们还发现无乳链球菌对红霉素和克林霉素的耐药性增加，以及出现了对青霉素不敏感的分离株。确定了大量由无乳链球菌菌株引起的侵袭性感染病例，大多发生在成年患者中。我们的研究结果强化了巴西对无乳链球菌采取控制措施的必要性，包括癌症患者。
