Clinical characteristics and outcomes of empyema caused by Streptococcus constellatus infection: a retrospective cohort study

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Background: Although Streptococcus constellatus (S. constellatus) infection is rare, it can cause severe suppurative abscesses. This study aims to analyze the clinical characteristics and outcomes of empyema caused by S. constellatus infection. Methods: This retrospective cohort study was conducted at West China Hospital of Sichuan University from January 2016 to April 2024. Patients were confirmed to be S. constellatus-positive via culture or Next-Generation Sequencing (NGS) of pleural effusion, with evidence of pyogenic infection foci. Patients under 18 years of age or with co-infections were excluded. Data collected included demographic characteristics, drug sensitivity test, ICU admission, and 30-day mortality. Results: A total of 64 patients were included, with 53 male patients. Diabetes was observed in 18 patients (28.12%). Five patients were confirmed with infection through NGS. Antimicrobial susceptibility testing revealed that 58 patients (98.31%) were susceptible to penicillin, whereas only 26.32% were susceptible to macrolides. 24 patients (37.5%) received carbapenems either alone or in combination with other agents. All patients underwent drainage treatment. 3 (4.69%) patients were admitted to the ICU, and the 30-day mortality rate was 1.56%. Conclusions: Although uncommon, S. constellatus infection can lead to severe empyema, particularly in patients with diabetes. Penicillin susceptibility was high; however, carbapenems were frequently used. All patients received drainage treatment, and the 30-day mortality was low. These findings highlight the importance of appropriate antibiotic selection and timely drainage.

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