链球菌 pyogenes 是一个病原体或乘客在不复杂的急性喉痛吗? 一个系统的审查和元分析
Patrycja Woldan-Gradalska1, Wojciech Gradalski2, Ronny K Gunnarsson3
1General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden; Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden; Sätila Primary Health Care Centre, Sätila, Sweden.
对Streptococcus pyogenes的阳性喉抽样高度表明成年人感染,但对儿童来说不那么重要. 一个负的抽样有效地排除了两年龄组的A组链球菌.
科学领域:
- 传染性疾病 传染性疾病
- 微生物学 微生物学
- 流行病学 流行病学
背景情况:
- 菌 (Streptococcus pyogenes),也被称为A组菌 (GAS),是导致喉疼痛的常见原因.
- 准确的诊断对于适当的治疗和预防并发症至关重要.
- 诊断测试的预测值可以受到各种因素的影响,包括患者人口统计和临床表现.
研究的目的:
- 估计一个阳性S. pyogenes喉抽样反映了喉疼痛的实际原因的概率.
- 为了研究年龄的影响,S. pyogenes载体率,以及气候对喉拭子的诊断效用.
- 确定S. pyogenes在喉疼痛患者中检测的病因预测值.
主要方法:
- 在2023年10月之前,对Medline和Scopus进行了系统的文献搜索.
- 包括病例控制研究报告S. pyogenes在患有喉疼痛的患者和健康对照者的患病率,儿童和成人有单独的数据.
- 积极和消极的病因预测值 (P-EPV和N-EPV) 被计算来评估诊断准确性.
主要成果:
- 分析包括15项研究.
- 对于S. pyogenes的整体P-EPV在儿童中为63%,在成年人中为92%.
- 在考虑具有3-4个Centor标准的患者时,P-EPV在儿童中增加到83%,在成人中增加到94%. 总的来说,N-EPV在两组中都很高 (97%的儿童,96%的成人).
结论:
- 在患有急性喉疼痛的成年人中检测S. pyogenes对于确认诊断非常有用.
- 选择 3-4 个 Centor 标准的孩子可以显著改善 S. pyogenes 的 P-EPV.
- 阴性喉抽样结果是排除S. pyogenes作为儿童和成人喉疼痛的原因的可靠指标.
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