在流行病后的时代,在儿童中发展入侵性Streptococcus pyogenes的治疗策略
Laura Buricchi1, Giuseppe Indolfi2,3, Marco Renni1,4
1Department of Health Science, University of Florence, Florence, Italy.
Clinical and experimental pediatrics
|August 14, 2025
概括
儿童的侵入性A组链球菌 (iGAS) 感染在流行病后增加,肺炎是常见的表现. 利尼佐利德作为治疗失败的二线疗法具有前景,而IVIG的使用需要进一步研究.
科学领域:
- 儿童传染病 儿童传染病
- 细菌学 细菌学是一门学科.
- 临床微生物学 临床微生物学
背景情况:
- 甲组链球菌 (GAS) 引起喉炎和皮肤感染,侵入性GAS (iGAS) 感染对儿童构成严重风险.
- COVID-19大流行与iGAS病例的增加相关,受年龄,免疫力减弱和病毒共感染等因素的影响.
- 标准的iGAS治疗方法 (克林达米辛,IVIG) 在儿科缺乏标准化;linezolid正在作为一种潜在的替代品出现.
研究的目的:
- 评估iGAS治疗在住院儿童中的有效性.
- 为了评估治疗失败或严重感染的线索利德等替代干预措施.
- 在iGAS病例中识别儿科重症监护室 (PICU) 入院的风险因素.
主要方法:
- 从2022年9月到2024年9月,对儿童 (<18岁) 进行iGAS的回顾性观察研究.
- 收集的数据包括人口统计,症状,实验室结果,微生物学,共感染,疗法和结果.
- 专注于治疗策略,包括标准和替代抗生素/非抗生素干预措施.
主要成果:
- 包括46名患有IGAS的儿童;16人需要接受PICU治疗,2人死亡.
- 肺炎与副肺/肺是最常见的表现.
- 在beta-lactam和clindamycin失败后,linezolid在5例 (10.9%) 中使用;升高的CRP/procalcitonin预测了PICU入院.
结论:
- iGAS治疗和疾病模式在流行后发生了变化,肺炎是其中一个关键的表现.
- 在儿科iGAS中,线索利德是可行的二线选择,其次是β-lactam和克林达米辛在儿科iGAS中失败.
- 在严重的IGAS病例中,静脉注射免疫球蛋白 (IVIG) 的使用往往会延迟,因此需要进一步研究最佳时间和疗效.
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