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严重的儿科侵入性A组链球菌病的危险因素
Evelien B van Kempen1,2,3, Adam J Tulling3, Erik G J von Asmuth3
1Department of Pediatrics, Juliana Children's Hospital, Haga Hospital, the Hague, the Netherlands.
JAMA network open
|August 19, 2025
概括
儿科入侵性A组链球菌 (iGAS) 病例在COVID-19后显著增加,严重程度和死亡率更高. 严重iGAS的危险因素包括肺部干扰,链球菌毒性休克综合征 (STSS) 和神经症状.
科学领域:
- 儿童传染病 儿童传染病
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 从2022年初开始,荷兰观察到小儿侵袭性A组链球菌 (iGAS) 疾病的增加.
- iGAS感染可以从轻微到危及生命的,需要及时的临床数据进行公共卫生决策.
研究的目的:
- 确定严重儿科iGAS的风险因素,定义为需要进入重症监护室和/或导致死亡.
- 分析儿科iGAS发病率,临床表现和流行病前,流行病前和流行病后的结果.
主要方法:
- 一项观察性,回顾性和前性队列研究,涉及2015年1月至2024年6月在荷兰的20家医院.
- 包括0至17岁的儿童被诊断患有IGAS.
- 统计分析包括风险因素的后勤回归和发病率比率的波松回归.
主要成果:
- 在COVID-19大流行期间iGAS病例减少,在COVID-19后期显著增加 (IRR,2.93).
- 与严重iGAS相关的因素包括COVID-19后的诊断,肺部参与,链球菌毒性休克综合征 (STSS) 和脑膜炎/脑炎.
- 疫情后的疾病严重程度增加,死亡率高 (4.4%vs1.4%) 和ICU入院率高 (38.4%vs15.6%),与疫情前相比.
结论:
- 复杂的儿科iGAS的危险因素包括肺部或中枢神经系统的参与,STSS,意识减弱,肺部临床症状,CRP升高和eGFR降低.
- 对这些风险因素的认识对于及时识别和改善儿童iGAS风险病例的临床结果至关重要.
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