Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Clin Infect Dis. 2023 Nov 17;77(10):1361-1371. doi: 10.1093/cid/ciad378.
Many community-acquired pleural infections are caused by facultative and anaerobic bacteria from the human oral microbiota. The epidemiology, clinical characteristics, pathogenesis, and etiology of such infections are little studied. The aim of the present prospective multicenter cohort study was to provide a thorough microbiological and clinical characterization of such oral-type pleural infections and to improve our understanding of the underlying etiology and associated risk factors.
Over a 2-year period, we included 77 patients with community-acquired pleural infection, whereof 63 (82%) represented oral-type pleural infections. Clinical and anamnestic data were systematically collected, and patients were offered a dental assessment by an oral surgeon. Microbial characterizations were done using next-generation sequencing. Obtained bacterial profiles were compared with microbiology data from previous investigations on odontogenic infections, bacteremia after extraction of infected teeth, and community-acquired brain abscesses.
From the oral-type pleural infections, we made 267 bacterial identifications representing 89 different species. Streptococcus intermedius and/or Fusobacterium nucleatum were identified as a dominant component in all infections. We found a high prevalence of dental infections among patients with oral-type pleural infection and demonstrate substantial similarities between the microbiology of such pleural infections and that of odontogenic infections, odontogenic bacteremia, and community-acquired brain abscesses.
Oral-type pleural infection is the most common type of community-acquired pleural infection. Current evidence supports hematogenous seeding of bacteria from a dental focus as the most important underlying etiology. Streptococcus intermedius and Fusobacterium nucleatum most likely represent key pathogens necessary for establishing the infection.
许多社区获得性胸腔感染是由人类口腔微生物群中的兼性和厌氧细菌引起的。这些感染的流行病学、临床特征、发病机制和病因学研究甚少。本前瞻性多中心队列研究的目的是对这种口腔型胸腔感染进行全面的微生物学和临床特征描述，并加深我们对潜在病因和相关危险因素的认识。
在两年期间，我们纳入了 77 例社区获得性胸腔感染患者，其中 63 例（82%）为口腔型胸腔感染。系统收集了临床和病史数据，并由口腔外科医生为患者提供口腔评估。使用下一代测序进行微生物特征分析。获得的细菌谱与先前关于牙源性感染、感染牙齿拔除后菌血症和社区获得性脑脓肿的微生物学数据进行了比较。
从口腔型胸腔感染中，我们共鉴定出 267 种细菌，代表 89 个不同的物种。中间链球菌和/或核梭杆菌被鉴定为所有感染的主要成分。我们发现口腔型胸腔感染患者中存在较高的口腔感染患病率，并证明了这种胸腔感染与牙源性感染、牙源性菌血症和社区获得性脑脓肿的微生物学之间存在显著相似性。
口腔型胸腔感染是最常见的社区获得性胸腔感染类型。现有证据支持细菌从口腔病灶血行播散是最重要的潜在病因。中间链球菌和核梭杆菌很可能代表了建立感染所需的关键病原体。
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