Ben-Abraham R, Keller N, Vered R, Harel R, Barzilay Z, Paret G
Dept of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Infection. 2002 Apr;30(2):81-5. doi: 10.1007/s15010-002-1182-6.
Invasive group A streptococcal (GAS) infections are increasing alarmingly worldwide.
To determine the clinical and epidemiologic characteristics of invasive GAS in a large tertiary medical center, we retrospectively surveyed microbiology and medical records of patients with invasive GAS infections (isolation of Group A Streptococcus from a normally sterile site) treated in our hospital from January 1995 to December 1997.
70 patients with a median age of 48 years (range 2 months-88 years) were identified. Of the 70 identified, 53 (76%) were adults (age > or = 19 years). The most common co-morbid diseases for invasive GAS in adults were diabetes mellitus, congestive heart failure (CHF), malignancy and immunosuppression. A probable port of entry was identified in 31 (44%) of the cases. In children, varicella lesions were the major port of entry. Overall mortality rate was 17%: The difference in mortality between pediatric and adult cases was significant (0/17 vs 12/53, respectively; p = 0.03). Toxic shock syndrome (TSS) and necrotizing fasciitis were identified in 8.6% and 5.7% of the cases, respectively, with mortalities of 83.3% and 25%. Hyponatremia and hypocalcemia were more frequently observed among the severely ill.
Invasive GAS infections tend to have an unexpected course and a broad clinical spectrum, ranging from local skin or pharyngeal involvement to deeply invasive fasciitis with TSS and high mortality. The elderly and those with underLying medical conditions are at utmost rsk for invasive GAS. Clear-cut guidelines for early therapeutic strategy, i.e. antibiotic administration and preemptive hospital admission are needed for community-based physicians.
侵袭性A组链球菌（GAS）感染在全球范围内正以惊人的速度增加。
为确定一家大型三级医疗中心侵袭性GAS的临床和流行病学特征，我们回顾性调查了1995年1月至1997年12月在我院接受治疗的侵袭性GAS感染患者（从正常无菌部位分离出A组链球菌）的微生物学和病历记录。
共确定70例患者，中位年龄48岁（范围2个月至88岁）。在这70例确诊患者中，53例（76%）为成年人（年龄≥19岁）。成人侵袭性GAS最常见的合并症是糖尿病、充血性心力衰竭（CHF）、恶性肿瘤和免疫抑制。31例（44%）病例中确定了可能的感染入口。在儿童中，水痘皮损是主要的感染入口。总体死亡率为17%：儿童和成人病例的死亡率差异显著（分别为0/17和12/53；p = 0.03）。中毒性休克综合征（TSS）和坏死性筋膜炎分别在8.6%和5.7%的病例中被发现，死亡率分别为83.3%和25%。重症患者中低钠血症和低钙血症更为常见。
侵袭性GAS感染往往病程意外且临床谱广泛，从局部皮肤或咽部受累到伴有TSS的深部侵袭性筋膜炎，死亡率高。老年人和有基础疾病的人患侵袭性GAS的风险最大。社区医生需要明确的早期治疗策略指南，即抗生素给药和预防性住院治疗。
