目的： 分析成人链球菌属感染致脓胸患者的临床特征，以指导诊治策略制定和预后评估。方法： 回顾分析2019年12月至2025年9月间在武汉大学人民医院经胸腔积液培养和（或）血培养确诊为链球菌属感染的28例成人脓胸患者的临床特征，根据其是否存在合并症和（或）免疫抑制状态，将其分为无危险因素组（n=8）和有危险因素组（n=20），收集并比较2组患者的基线资料、临床表现以及实验室检查、病原学检查结果和治疗方案、临床转归。结果： 本研究共收治脓胸患者440例，其中链球菌属感染所致脓胸占6.4%。28例患者的CT图像表现均符合胸腔积液的特征，且大多数（19例）积液呈包裹性，临近胸膜增厚。其中，双侧脓胸最为常见（46.43%），其次为右侧（35.71%）和左侧（17.86%）。星座链球菌是链球菌属感染导致脓胸患者的主要致病菌（占50%）；中间链球菌仅见于无危险因素组；其他菌属包括咽峡炎链球菌、缓症链球菌、肺炎链球菌和口腔链球菌。无危险因素组与有危险因素组患者间的平均年龄、发热比例、全身炎症指标[白细胞计数、C反应蛋白、降钙素原（procalcitonin，PCT）]差异均无统计学意义（P均>0.05）。无危险因素组有5例出现肝功能损伤，发生率高于有危险因素组的趋势（5/8比3/20，P=0.05）。2组患者培养获得的所有菌株对一线β-内酰胺类药物均敏感，2组的耐药率无统计学差异（P均>0.05）。治疗转归方面，有危险因素组与无危险因素组患者间的抗感染时间及住院时间的差异均无统计学意义，有危险因素组有3例（3/20）患者因脓胸及其引起的并发症而死亡。28例脓胸患者中，8例接受外科手术治疗的患者，无论是否存在危险因素，均好转出院。结论： 星座链球菌是导致成人脓胸的重要致病菌。无合并症和（或）免疫抑制状态的患者，肝功能损害发生率更高。治疗方面，药敏结果显示，一线β-内酰胺类药物（青霉素/头孢菌素）仍高度有效，但需警惕对克林霉素等药物的普遍耐药。对于脓胸患者，宜在充分抗感染治疗的基础上，尽早进行胸腔闭式引流。

Objective This study analyzes the clinical characteristics of adult patients with empyema caused by Streptococcus infection, aiming to inform the formulation of diagnostic and treatment strategies as well as prognostic evaluation. Methods A retrospective analysis was conducted on the clinical characteristics of 28 adult patients with empyema confirmed by pleural fluid culture and/or blood culture for Streptococcus at Renmin Hospital of Wuhan University between December 2019 and September 2025. The patients were divided into a group without risk factors (n=8) and a group with risk factors (n=20) based on the presence of comorbidities and/or immunosuppression. The baseline data, clinical manifestations, laboratory and etiological findings, treatment modalities, and clinical outcomes were collected and compared between the two groups. Results A total of 440 patients with empyema were enrolled in this study, among whom empyema caused by Streptococcus infection accounted for 6.4%. CT images of all 28 patients were consistent with the characteristics of pleural effusion, and most patients (19 cases) exhibited loculated effusion accompanied by adjacent pleural thickening. Among them, bilateral empyema was most common (46.43%), followed by right-sided (35.71%) and left-sided (17.86%) empyema. Streptococcus constellatus was the predominant pathogen causing empyema due to Streptococcus infection (50%). Streptococcus intermedius was detected exclusively in the group without risk factors. Other isolated species included Streptococcus anginosus, Streptococcus mitis, Streptococcus pneumoniae, and Streptococcus oralis. No statistically significant differences were observed between the group without risk factors and the group with risk factors in mean age, proportion of patients with fever, or systemic inflammatory markers [white blood cell count, C-reactive protein, procalcitonin (PCT)] (all P>0.05). Five patients in the group without risk factors developed liver function impairment, and the incidence showed a tendency to be higher than that in the group with risk factors (5/8 vs. 3/20 cases, P=0.05). All strains isolated from both groups were susceptible to first-line β-lactam antibiotics, and no significant differences in resistance rates were observed between the two groups (all P>0.05). Regarding clinical outcomes, no significant differences were found in the duration of anti-infective therapy or hospital stay between the two groups. Three patients (3/20, 15.0%) in the group with risk factors died due to empyema and its directly related complications. Among the 28 patients, eight underwent surgical intervention, all of whom improved and were discharged, regardless of risk factor status. Conclusion Streptococcus constellatus is a major pathogen causing adult empyema. Patients without comorbidities and/or immunosuppression have a higher incidence of liver function impairment. In terms of treatment, antimicrobial susceptibility results indicate that first-line β-lactam antibiotics (penicillins/cephalosporins) remain highly effective. However, widespread resistance to clindamycin and other agents warrants attention. For patients with empyema, closed thoracic drainage should be performed as early as possible on the basis of adequate anti-infective therapy.