Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France.
Centre National de Référence des Streptocoques, Paris, France.
Microbiol Spectr. 2023 Jun 15;11(3):e0016023. doi: 10.1128/spectrum.00160-23. Epub 2023 May 18.
Non-beta-hemolytic streptococci (NBHS), also referred to as streptococci, represent an underestimated cause of human invasive diseases. Their resistance to antibiotics, including beta-lactam agents, often complicate their therapeutic management. A prospective multicenter study was conducted by the French National Reference Center for Streptococci between March and April 2021 to describe the clinical and microbiological epidemiology of invasive infections due to NBHS, excluding pneumococcus. A total of 522 NBHS invasive cases were collected. Distribution among streptococcal groups was: Streptococcus anginosus (33%), Streptococcus mitis (28%), Streptococcus sanguinis (16%), Streptococcus bovis (15%), Streptococcus salivarius (8%), and Streptococcus mutans (<1%). Median age of infection was 68 years old (range <1 day to 100 years). Cases were more frequent in male patients (gender ratio M/F 2.1:1) and manifested mainly as bacteremia without focus (46%), intra-abdominal infections (18%) and endocarditis (11%). All isolates were susceptible to glycopeptides and displayed low-level inherent gentamicin resistance. All isolates of the S. bovis, , and S. mutans groups were susceptible to beta-lactams. Conversely, nonsusceptibility to beta-lactams was found in 31%, 28%, and 52% of S. mitis, , and S. sanguinis isolates, respectively. The screening for beta-lactam resistance using the recommended one unit benzylpenicillin disk screening failed to detect 21% of resistant isolates (21/99). Last, overall resistance rates to the alternative anti-streptococcal molecules clindamycin and moxifloxacin were 29% (149/522) and 1.6% (8/505), respectively. NBHS are recognized as opportunistic pathogens particularly involved in infections of the elderly and immunocompromised patients. This study underlines their importance as common causes of severe and difficult-to-treat infections such as endocarditis. Although species of the and S. bovis/ groups remain constantly susceptible to beta-lams, resistance in oral streptococci exceeds 30% and screening techniques are not fully reliable. Therefore, accurate species identification and antimicrobial susceptibility testing by MICs determination appears essential for the treatment of NBHS invasive infections, together with continued epidemiological surveillance.
非-β-溶血性链球菌(NBHS),也称为链球菌,是被低估的人类侵袭性疾病的病因。它们对抗生素(包括β-内酰胺类药物)的耐药性常常使治疗管理复杂化。2021 年 3 月至 4 月,法国国家链球菌参考中心进行了一项前瞻性多中心研究,描述了排除肺炎球菌的 NBHS 引起的侵袭性感染的临床和微生物流行病学。共收集了 522 例 NBHS 侵袭性病例。链球菌组的分布为:咽峡炎链球菌(33%)、米氏链球菌(28%)、血链球菌(16%)、牛链球菌(15%)、唾液链球菌(8%)和变异链球菌(<1%)。感染的中位年龄为 68 岁(范围为<1 天至 100 岁)。男性患者更为常见(男女比例 2.1:1),主要表现为无病灶的菌血症(46%)、腹腔内感染(18%)和心内膜炎(11%)。所有分离株均对糖肽类药物敏感,且具有低水平固有庆大霉素耐药性。牛链球菌、 和变异链球菌组的所有分离株均对β-内酰胺类药物敏感。相反,米氏链球菌、 和血链球菌分离株对β-内酰胺类药物的不敏感性分别为 31%、28%和 52%。使用推荐的一单位苯唑西林纸片筛选β-内酰胺耐药性的方法未能检测到 21%的耐药分离株(21/99)。最后,克林霉素和莫西沙星这两种替代抗链球菌药物的总耐药率分别为 29%(149/522)和 1.6%(8/505)。NBHS 被认为是机会性病原体,特别是与老年人和免疫功能低下患者的感染有关。本研究强调了它们作为严重和治疗困难的感染(如心内膜炎)常见病因的重要性。虽然 和牛链球菌/组的物种仍然对β-内酰胺类药物保持持续敏感性,但口腔链球菌的耐药率超过 30%,且筛选技术并非完全可靠。因此,对于 NBHS 侵袭性感染的治疗,准确的物种鉴定和通过 MIC 测定进行药敏试验似乎至关重要,同时还需要进行持续的流行病学监测。