Muñoz P, Llancaqueo A, Rodríguez-Créixems M, Peláez T, Martin L, Bouza E
Department of Microbiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Arch Intern Med. 1997 Jan 27;157(2):213-6. doi: 10.1001/archinte.1997.00440230087011.
We report the largest series of group B streptococcal (GBS) bacteremia cases reported at a single institution.
During a 10-year period (1985-1994), 90 GBS bacteremia cases (0.95% of significant bacteremic episodes) were detected. We describe the 51 episodes that occurred in nonpregnant adults for which enough clinical and microbiological information is available.
Incidence of GBS has significantly increased during the study period (from 0.08 per 1000 admissions in 1985 to 0.3 per 1000 in 1994). Mean age of patients was 63.3 years (range, 21-88 years) and 53% were men. The most common underlying conditions were liver diseases (35.3%), malignancies (33.3%), and diabetes mellitus (27.5%). Only 2 patients did not have any underlying condition and no patient with the human immunodeficiency virus had GBS bacteremia in our series. The origins of the episodes of bacteremia were as follows: primary bacteremia (39.2%), skin and soft tissue infections (15.7%), urinary tract infections (11.8%), pneumonia (9.8%), peritonitis (9.8%), catheter infection (5.9%), postendoscopic bacteremia (5.9%), and endocarditis (2%). All isolates were susceptible to penicillin G potassium, ampicillin sodium, cephalothin sodium, cefotaxime sodium, and vancomycin hydrochloride. One ciprofloxacin hydrochloride-resistant strain was discovered and resistance to erythromycin stearate increased from 8% in 1992 to 18% in 1994. The overall mortality rate was 33.3% and deaths were considered related to the GBS bacteremia in 25.5% of the cases. Factors for poor prognosis were central nervous system diseases, alcoholism, shock, renal failure, and consciousness impairment.
Group B streptococcus is a rising cause of bacteremia in elderly patients with severe underlying conditions. It conveys high morbidity and mortality rates. Macrolides should not be used empirically for treatment of patients with penicillin allergies.
我们报告了在单一机构所报道的最大系列的B组链球菌（GBS）菌血症病例。
在10年期间（1985 - 1994年），检测到90例GBS菌血症病例（占严重菌血症发作的0.95%）。我们描述了在非妊娠成人中发生的51例病例，这些病例有足够的临床和微生物学信息。
在研究期间，GBS的发病率显著增加（从1985年每1000例入院患者中的0.08例增至1994年的每1000例中的0.3例）。患者的平均年龄为63.3岁（范围21 - 88岁），53%为男性。最常见的基础疾病是肝脏疾病（35.3%）、恶性肿瘤（33.3%）和糖尿病（27.5%）。只有2例患者没有任何基础疾病，在我们的系列中没有人类免疫缺陷病毒患者发生GBS菌血症。菌血症发作的来源如下：原发性菌血症（39.2%）、皮肤和软组织感染（15.7%）、尿路感染（11.8%）、肺炎（9.8%）、腹膜炎（9.8%）、导管感染（5.9%）、内镜检查后菌血症（5.9%）和心内膜炎（2%）。所有分离株对青霉素G钾、氨苄西林钠、头孢噻吩钠、头孢噻肟钠和盐酸万古霉素敏感。发现1株对盐酸环丙沙星耐药的菌株，对硬脂酸红霉素的耐药率从1992年的8%增至1994年的18%。总死亡率为33.3%，25.5%的病例死亡被认为与GBS菌血症有关。预后不良的因素是中枢神经系统疾病、酗酒、休克、肾衰竭和意识障碍。
B组链球菌是有严重基础疾病的老年患者菌血症的一个日益增多的病因。它导致高发病率和死亡率。对于青霉素过敏的患者，不应经验性使用大环内酯类药物进行治疗。
