From the Pediatric department and Infectious Diseases Unit, Shaare Zedek Medical Center affiliated with Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
Pediatr Infect Dis J. 2020 Sep;39(9):799-802. doi: 10.1097/INF.0000000000002699.
Streptococcus pneumoniae is the most common cause of complicated pneumonia in children, but its incidence is decreasing since the introduction of the antipneumococcal conjugated vaccines. Streptococcus pyogenes is an uncommon cause of community-acquired pleuropneumonia/empyema in children, but its relative incidence is rising.
The medical records of all children 0-18 years of age from 2004 to 2019, with discharge diagnoses of pleuropneumonia or empyema, and a positive blood and/or pleural effusion culture for group A streptococcus (GAS) (S. pyogenes), or S. pneumonia (SP) were reviewed. A comparison of clinical and laboratory characteristics for the 2 etiologies was performed.
Ninety cases of community-acquired pleuropneumonia/empyema caused by these organisms were included: 20 GAS and 70 SP. Compared with children with SP, those with GAS were more likely to have larger pleural effusion requiring drainage and longer hospitalization, and less likely to have a positive blood culture. The relative portion of GAS empyema increased over the study period.
Compared with patients with SP empyema, GAS appears to cause more morbidity and a longer hospital stay. This organism is more frequently recovered from pleural fluid without bacteremia, and thus necessitates pleural fluid tap for accurate diagnosis.
肺炎链球菌是儿童复杂性肺炎的最常见病因，但自从引入抗肺炎球菌结合疫苗以来，其发病率有所下降。酿脓链球菌是儿童社区获得性脓胸/积脓的不常见病因，但相对发病率正在上升。
回顾了 2004 年至 2019 年所有 0-18 岁因脓胸或积脓而出院诊断为 A 组链球菌（酿脓链球菌）（S. pyogenes）或肺炎链球菌（SP）阳性血和/或胸腔积液培养的儿童的病历。比较了两种病因的临床和实验室特征。
共纳入 90 例由这些病原体引起的社区获得性脓胸/积脓：20 例酿脓链球菌和 70 例肺炎链球菌。与肺炎链球菌组相比，酿脓链球菌组更有可能出现需要引流的大量胸腔积液和更长的住院时间，且血培养阳性的可能性更小。研究期间酿脓链球菌脓胸的相对比例有所增加。
与肺炎链球菌脓胸患者相比，酿脓链球菌似乎会导致更多的发病率和更长的住院时间。该病原体更常从无菌血症的胸腔积液中回收，因此需要胸腔积液穿刺以进行准确诊断。
