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侵袭性A组链球菌感染需要入院的ICU:一个全国性的,多中心,回顾性研究 (ISTRE研究)
Arthur Orieux1, Renaud Prevel2,3, Margot Dumery2
1Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France. arthur.orieux@chu-bordeaux.fr.
Critical care (London, England)
|January 3, 2024
概括
在COVID-19大流行措施后,A组侵袭性链球菌感染显著升,链球菌毒性休克状综合征 (STSS) 的发病率较高,但ICU死亡率没有增加.
科学领域:
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
- 流行病学 流行病学
背景情况:
- 甲组链球菌 (GAS) 引起严重的侵入性疾病,如链球菌毒性休克状综合征 (STSS),需要进入重症监护室 (ICU).
- 在COVID-19流行病后的儿科人口中,侵袭性GAS (iGAS) 感染的增加已被注意到.
- 法国ICU的临床观察表明,大流行后成年人中iGAS感染的增加,促使客观调查.
研究的目的:
- 为了比较法国成年人ICU中COVID-19大流行前后iGAS感染的发生率.
- 为了描述患者的临床特征被录取到ICU与IGAS感染.
- 为了确定与IGAS感染患者的ICU死亡率相关的因素.
主要方法:
- 在37个法国ICU进行了一项回顾性,多中心的队列研究.
- 数据收集了两段时间:两年大流行前 (2018年10月至2020年3月) 和一年大流行后 (2022年10月至2023年3月).
- 通过ICD代码和微生物学数据库识别的,从无菌地点隔离GAS来定义iGAS感染;发病率是按每10万个ICU入院病例率计算的.
主要成果:
- 总共有222名患者因IGAS感染而入院 (73名流行前,149名流行后).
- 在流行后,iGAS感染的发病率从每10万个ICU入院患者中从205个增加到949个 (p < 0.001).
- 链球菌毒性冲击类综合征 (STSS) 在流行后更频繁 (61%对45%,p=0.015),尽管ICU死亡率保持相似 (19%整体,14%前对22%后,p=0.135).
结论:
- 在COVID-19大流行后,需要ICU入院的IGAS感染的发生率大幅增加 (4-5倍).
- 虽然STSS的发病率在流行后较高,但整体ICU死亡率并没有显著增加.
- 与ICU死亡率相关的因素包括侵入性机械通风,STSS,急性损伤,免疫抑制和糖尿病.
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