Salavert M, Gómez L, Rodriguez-Carballeira M, Xercavins M, Freixas N, Garau J
Department of Internal Medicine, Hospital Mútua de Terrassa, Universidad de Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 1996 May;15(5):365-71. doi: 10.1007/BF01690091.
The Streptococcus milleri group is associated with a spectrum of serious suppurative infections that have not been well defined. The purposes of this study were to ascertain the clinical significance of Streptococcus milleri bacteremia and to determine the epidemiological, clinical, and microbiological features of these infections compared to those caused by other viridans streptococci. All cases of streptococcal bacteremia observed in a Spanish hospital in the period from January 1988 to December 1994 were reviewed. Of 137 cases of Streptococcus milleri infection, 33 (24%) were documented cases of bacteremia. Twenty-four patients were men (mean age 57.8 +/- 17.4 years). The majority of infections were abdominal in origin (20/33), the most frequent diagnoses being cholangitis/cholecystitis (18%) and appendicitis (12%). The origin of infection could not be established in three cases. Nine cases of bacteremia (27%) were polymicrobial. Six patients (18%) had septic shock; in four the infection was polymicrobial, and in two the infection was of abdominal origin. Eighteen of the 33 patients (54%) required surgery. Five patients died. All 33 Streptococcus milleri isolates were susceptible to penicillin. Twenty-two cases of bacteremia caused by other viridans streptococci were observed during the same period. There were no statistically significant differences between the two groups in terms of age, sex, mortality, rate of polymicrobial infection, rate of nosocomial acquisition of bacteremia, or the occurrence of shock. An abdominal origin of infection was more frequent in Streptococcus milleri bacteremia (p = 0.0001); a cardiovascular origin was more frequent in the viridans group (p = 0.01), as was a diagnosis of endocarditis (p = 0.004). Four patients with viridans streptococci bacteremia required surgery versus 18 patients with Streptococcus milleri bacteremia (p = 0.01). Viridans streptococci were notably less susceptible to penicillin (89%), clindamycin (79%), and erythromycin (79%).
米勒链球菌组与一系列尚未明确界定的严重化脓性感染相关。本研究的目的是确定米勒链球菌菌血症的临床意义，并确定这些感染与其他草绿色链球菌所致感染相比的流行病学、临床和微生物学特征。回顾了1988年1月至1994年12月期间在一家西班牙医院观察到的所有链球菌菌血症病例。在137例米勒链球菌感染病例中，33例（24%）有菌血症记录。24例患者为男性（平均年龄57.8±17.4岁）。大多数感染起源于腹部（20/33），最常见的诊断是胆管炎/胆囊炎（18%）和阑尾炎（12%）。3例感染源无法确定。9例菌血症（27%）为多微生物感染。6例患者（18%）发生感染性休克；4例感染为多微生物感染，2例感染起源于腹部。33例患者中有18例（54%）需要手术。5例患者死亡。所有33株米勒链球菌分离株对青霉素敏感。同期观察到22例由其他草绿色链球菌引起的菌血症。两组在年龄、性别、死亡率、多微生物感染率、医院获得性菌血症发生率或休克发生率方面无统计学显著差异。米勒链球菌菌血症中感染起源于腹部的情况更为常见（p = 0.0001）；草绿色链球菌组中心血管起源更为常见（p = 0.01），心内膜炎诊断也是如此（p = 0.004）。草绿色链球菌菌血症患者中有4例需要手术，而米勒链球菌菌血症患者中有18例需要手术（p = 0.01）。草绿色链球菌对青霉素（89%）、克林霉素（79%）和红霉素（79%）的敏感性明显较低。
