The Clinical Features and Management of Empyema Caused by Streptococcus constellatus

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.

Empyema caused by Streptococcus constellatus in a patient infected with HIV: a case report and literature review

“…The presence of anaerobes can positively enhance infection of S. constellatus, and associated with a high incidence of lung abscess and mortality. The potential mechanism was that anaerobes and its metabolite inhibit the bactericidal activity of the host and stimulate the growth of S. constellatus, by impairing the function of polymorphonuclear leukocytes (PMNLs) [ 22 , 23 ]. So antibiotics should against both S. constellatus and anaerobes.…”

Severe pneumonia with empyema caused by Parvimonas micra and Streptococcus constellatus co-infection: a case report

“…A previous study showed that as many as 55.6% of pulmonary infections caused by S. constellatus manifest as a pleural effusion or empyema, making empyema more common with S. constellatus than other bacterial species. 23 This suggests that S. constellatus should be considered a possible causative pathogen in patients with lung infections presenting with empyema. The risk factors for S. constellatus infections are similar to those for P. micra infections (i.e., immunocompromised hosts with conditions such as diabetes mellitus, malignancy, or chronic obstructive pulmonary disease).…”

“…25 S. constellatus does not grow well in aerobic conditions but grows more readily in 5% CO 2 or under anaerobic conditions. Lin et al 23 showed that S. constellatus is often co-isolated with anaerobes in empyema. The mechanism of action is as follows: (i) anaerobic bacteria and their metabolites inhibit the ability of leukocytes to phagocytose aerobic bacteria; (ii) anaerobic bacteria can provide (i.e., synthesize) essential nutrients for bacterial growth, such as vitamin K, succinate, and various growth factors; and (iii) these bacteria can alter the local environment (including lowering oxygen tension and reducing redox potential) and produce substances that are toxic to the host, allowing various species of bacteria to reproduce concurrently.…”

Empyema caused by streptococcus constellatus in a patient infected with HIV: a case report and literature review

“…The S. constellatus tends to co-infect with other anaerobes [13]. Lin et al [20] held the opinion that anaerobes may involve and aggravate S. constellatus empyema, antibiotics should against both S. constellatus and anaerobes. Another study [21] demonstrated that the presence of anaerobes can positively enhance infection of S. constellatus, and associated with a high incidence of lung abscess and mortality.…”