Harrison L H, Ali A, Dwyer D M, Libonati J P, Reeves M W, Elliott J A, Billmann L, Lashkerwala T, Johnson J A
Department of International Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Ann Intern Med. 1995 Sep 15;123(6):421-7. doi: 10.7326/0003-4819-123-6-199509150-00004.
To study recurrent group B streptococcal infection in adults.
Patients with more than one reported group B streptococcal infection were identified through active surveillance for this infection. Sterile-site group B streptococcal isolates were evaluated for serotype and molecular subtyping using restriction endonuclease analysis of chromosomal DNA (REAC).
All acute-care hospitals in Maryland.
Nonpregnant residents of Maryland 18 years of age or older.
22 adults had at least two group B streptococcal episodes that were separated by 2 to 95 weeks (mean, 24 weeks). Of 395 patients with invasive group B streptococcal infection who survived the first episode and were followed for at least 1 year, 17 (4.3% [95% CI, 2.6% to 6.9%]) had more than one episode. Several patients were found to have endocarditis or osteomyelitis during the second episode. Group B streptococcal isolates from both episodes were obtained from 18 of 22 patients. Of the 18 isolate pairs, 13 (72% [CI, 46% to 90%]) had identical REAC patterns; the probability that at least 13 matches would be found by chance alone was less than 0.000001. Among patients with recurrent infection caused by the same strain, the interval between episodes was shorter (mean, 14 weeks) than that among patients with recurrent infection caused by another strain (mean, 43 weeks; P = 0.05).
Recurrent group B streptococcal infection is common among adults and in most cases appears to be caused by relapse. The optimal management of adults with a first episode of group B streptococcal infection needs to be further defined to minimize the likelihood of recurrent disease.
研究成人B族链球菌复发性感染。
通过对该感染进行主动监测，识别出报告有不止一次B族链球菌感染的患者。使用染色体DNA限制性内切酶分析（REAC）对无菌部位的B族链球菌分离株进行血清型和分子亚型评估。
马里兰州所有急症医院。
马里兰州18岁及以上的非妊娠居民。
22名成年人至少有两次B族链球菌发作，发作间隔为2至95周（平均24周）。在395例侵袭性B族链球菌感染患者中，首次发作存活且随访至少1年的患者有17例（4.3%[95%CI，2.6%至6.9%]）有不止一次发作。在第二次发作期间，发现数名患者患有心内膜炎或骨髓炎。22例患者中有18例获得了两次发作的B族链球菌分离株。在这18对分离株中，13对（72%[CI，46%至90%]）具有相同的REAC模式；仅靠偶然发现至少13对匹配的概率小于0.000001。在由同一菌株引起复发性感染的患者中，发作间隔（平均14周）短于由另一菌株引起复发性感染的患者（平均43周；P=0.05）。
B族链球菌复发性感染在成年人中很常见，且在大多数情况下似乎是由复发引起的。需要进一步明确首次发作B族链球菌感染的成年人的最佳管理方法，以尽量减少复发性疾病的可能性。
