-lactams, including penicillin, have been used for over 80 years in the treatment of group A Streptococcus (GAS) infections. Although -lactam-resistant GAS strains have not been identified in vitro tests, clinical treatment failures have been reported since the 1950s. The mechanism underlying the clinical failure of -lactam treatment in GAS infections remains unclear. Previous research has suggested that -lactam resistance in GAS in vivo is associated with reduced drug susceptibility of strains, bacterial inoculation effects, biofilm formation, the effect of coexisting bacteria, bacterial persistence, and bacterial internalization into host cells. This article reviews the main reports on -lactam treatment failure in GAS infections and analyzes the possible mechanisms of -lactam resistance in vivo. The findings aim to contribute to future research and clinical approaches in the field.
包括青霉素在内的-内酰胺类药物用于治疗A族链球菌（group A Streptococcus, GAS）感染已有80余年，虽然体外试验尚未发现对其耐药的GAS菌株，但自20世纪50年代以来，时有-内酰胺类药物临床治疗GAS感染失败的报道。GAS体内耐受-内酰胺类药物的机制尚未明确。已有研究提示，GAS体内耐受-内酰胺类药物与菌株对药物的敏感性降低、细菌的接种效应、生物膜的形成、共存菌的作用、细菌持留性及细菌可内化入胞内等因素有关。该文回顾总结了-内酰胺类药物临床治疗GAS感染失败的主要报道，以及与GAS体内耐受-内酰胺类药物机制相关的重要研究，为后续研究及临床用药提供参考。.
Keywords: -lactam; Group A Streptococcus; Penicillin; Streptococcus pyogenes; Treatment failure.