老年人B群鏈球菌軟組織感染之臨床表現與血清型

Serotypes and Clinical Features of Soft-tissue Infections Caused by Group B Streptococci in the Elderly

李南瑤(Nan-Yao Lee) ； 施欣怡(Hsin-I Shih) ； 李欣純(Hsin-Chun Lee) ； 吳綺容(Chi-Jung Wu) ； 柯文謙(Wen-Chien Ko)

《台灣老年醫學雜誌》 1卷2期 (2005/11) Pp. 89-97

https://doi.org/10.29462/TGG.200511.0005

摘要

目的：侵襲性B群鏈球菌疾病正逐年增加之中，特別是在老年人及有潛在疾病之患者，本研究之目的乃針對六十歲以上B群鏈球菌軟組織感染患者，探討其潛在疾病、疾病之嚴重程度、體外抗生素藥物敏感性測驗、血清型、治療及臨床預後之相關性。
方法：本研究自1993年1月至1999年1月間，針對南部某一醫學中心所有B群鏈球菌軟組織感染診斷之老人病例，加以回顧分析。B群鏈球菌之血清型和抗生素之藥物敏感性則分別利用凝集法(agglutination method)和瓊脂稀釋法(agar dilution method)來加以辨別分析。
結果：共有34位B群鏈球菌所造成之軟組織感染老年患者，其臨床表現包括蜂窩性組織炎、糖尿病足部感染、化膿性肌炎、皮下膿瘍、傷口感染和壞死性筋膜炎。最常見之潛在疾病為糖尿病，其次為惡性腫瘤。其中血清型Ⅴ是最常見之血清型(11, 37.9%)，其次是Ⅲ(8, 27.6%)、Ia(4, 13.8%)、Ib(3, 10.3%)和Ⅳ(3, 10.3%)。Penicillin仍然是治療B群鏈球菌軟組織感染之首選藥物。死亡率為11.8%(4/34)，而預後與疾病發生時之嚴重程度有關(P=0.01)。有7位(20.6%)患者在肢體上因B群鏈球菌軟組織感染而造成截肢，其主要危險因子為肢體存在有表皮潰瘍(P=0.004)。
結論：對於老年B群鏈球菌軟組織感染之患者，特別是合併有糖尿病，和威脅性軟組織感染患者，應及早提供適當皮膚照顧及合理抗生素使用，或合併外科治療，以期減少後續之併發症或死亡。

關鍵字

老年人 ； B群鏈球菌 ； 血清型 ； 軟組織感染

並列摘要

Objectives: The incidence of group B streptococcal (Streptococcus agalactiae, GBS) disease is increasing, particular in the elderly and those with underlying diseases. The aim of the study was to investigate the clinical features, serotype distribution, antimicrobial susceptibility, treatment and prognosis of soft-tissue infections caused by GBS in the elderly.
Methods: From January 1993 to January 1999, patients aged more than 60 years old, with soft-tissue infections caused by GBS, were retrospectively reviewed in a medical center in southern Taiwan. The causative pathogens were studied for antimicrobial susceptibility by agar dilution method and capsular serotype.
Results: A total of 34 patients with soft-tissue infections caused by S. agalactiae were enrolled. The spectrum of soft-tissue infections ranged from cellulitis, subcutaneous abscess, infected wound, diabetic foot infections, to pyomyositis, and necrotizing fasciitis. Diabetes mellitus was the most common underlying disease, followed by malignant neoplasm. Type V was the most frequent serotype (11, 37.9%), followed by type Ⅲ (8, 27.6%), Ia (4, 13.8%), Ib (3, 10.3%) and Ⅳ (3, 10.3%). Penicillin G remains the drug of choice in the treatment of GBS soft-tissue infections. Overall mortality was 11.8% (4/34). Critical illness at presentation heralded a fatal prognosis (P=0.01). Seven patients (20.6%) evolved into limb-threatening infections and received amputation of a limb. The significant risk factors for amputation was the presence of cutaneous ulceration (P=0.004).
Conclusion: Soft-tissue infections by GBS in the elderly will result in substantial morbidity and mortality. Intensive skin care, appropriate antimicrobial therapy and early surgical intervention were indicated in the elderly with diabetes and limb-threatening GBS infections.

並列關鍵字

elderly ； Streptococcus agalactiae ； serotype ； soft-tissue infection