The Clinical Features and Management of Empyema Caused by Streptococcus constellatus

Jinyan Lin; Yu Zhang; Chongxi Bao; Huasong Lu; Yun Zhong; Chuanfeng Huang; Qiuping Huang; Dezhen Wang; Jing Luo; Ke Wang; Jinliang Kong

doi:10.2147/IDR.S382484

The Clinical Features and Management of Empyema Caused by Streptococcus constellatus

Infect Drug Resist. 2022 Oct 28:15:6267-6277. doi: 10.2147/IDR.S382484. eCollection 2022.

Authors

Jinyan Lin^#¹, Yu Zhang^#¹, Chongxi Bao¹, Huasong Lu¹, Yun Zhong¹, Chuanfeng Huang¹, Qiuping Huang¹, Dezhen Wang¹, Jing Luo¹, Ke Wang¹, Jinliang Kong¹

Affiliation

¹ Pulmonary and Critical Care Medicine Ward, Guangxi Medical University First Affiliated Hospital, Nanning, People's Republic of China.

^# Contributed equally.

Abstract

Background: Streptococcus constellatus, a commensal, plays an important role in purulent infections. It has been reported as aggressive pathogen causing pleural empyema. But the role of S. constellatus in empyema has not been taken seriously. There are no studies about clinical characteristics of empyema caused by S. constellatus domestically and abroad. This study aimed to explore the clinical features and management of empyema caused by S. constellatus.

Methods: A retrospective review of 9 patients diagnosed with empyema caused by S. constellatus in a hospital between January 2010 and August 2021 was performed.

Results: S. constellatus empyema were mostly seen in old males (66.7%) with comorbid diseases. The high-risk factors include diabetes mellitus, oral infection, and oral surgery. All were unilateral encapsulated empyema (right-side, 55.6%), diagnosed with pneumonia (bilateral pneumonia, 88.9%; ipsilateral lung abscess, 44.4%). 33.3% of patients had S. constellatus and anaerobes co-isolated. S. constellatus were sensitive to penicillin G, linezolid, levofloxacin, vancomycin, ceftriaxone, and chloramphenicol, resistant to erythromycin, tetracycline, and clindamycin. 33.3% of the patients needed ventilator support. The primary treatment to S. constellatus empyema was timely pus drainage, intravenous antibiotics, and enough nutrition support, intrapleural fibrinolytics and surgery (VAST recommended first) in necessity.

Conclusion: S. constellatus may cause pneumonia and lung abscess first and then spread to cause empyema mainly in old males with comorbid diseases. S. constellatus often co-isolated with anaerobes in empyema. Antibiotics should cover simultaneously both S. constellatus and anaerobes.

Keywords: S. constellatus; anaerobes; clinical features; empyema.

Grants and funding

This project was supported by the National Natural Science Foundation of China (No. 82104499, No. 82160783, No. 81760743, No. 81760024, No. 82260023); the National Natural Science Foundation of Guangxi (2022GXNSFAA035646); the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region, self-funded projects (No. Z20200825); the Key Research Program of Guangxi Science and Technology Department (No. AB21196010); Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention (No. ZZH2020004); The First Affiliated Hospital of Guangxi Medical University Provincial and Ministerial Key Laboratory Cultivation Project: Guangxi Key Laboratory of Tropical Fungi and Mycosis Research (No. YYZS2020006); Guangxi Medical and Health Suitable Technology Development and Popularization Application Project (No. S2019090); the First Affiliated Hospital of Guangxi Medical University Clinical Research Climbing Program Youth Science and Technology Morning Star Program (No. 201903032); Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University.