Mulla Zuber D, Leaverton Paul E, Wiersma Steven T
Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA.
South Med J. 2003 Oct;96(10):968-73. doi: 10.1097/01.SMJ.0000051060.95210.9A.
Several previous studies of invasive Group A streptococcal (GAS) disease have been hindered by small sample sizes (< or = 100 patients) and limited generalizability.
We conducted a population-based study of invasive GAS disease. The objectives of the study were to describe the clinical features of individuals who were hospitalized for invasive GAS disease and to identify risk factors for hospital mortality. The cases were 257 patients who were hospitalized throughout Florida during a 4-year period and reported to the Florida Department of Health. Logistic regression was used to calculate adjusted odds ratios (OR) for mortality and 95% confidence intervals (CI).
The overall mortality was 18% (41 of 228). Admission into an intensive care unit was a strong predictor of mortality (OR, 20.41; 95% CI, 6.41-64.96). Treatment with clindamycin reduced mortality in patients who had necrotizing fasciitis (OR, 0.11; 95% CI, 0.01-0.89) but not in patients who did not have necrotizing fasciitis (OR, 1.01; 95% CI, 0.31-3.33).
Clindamycin reduces mortality in patients with invasive GAS disease who have necrotizing fasciitis.
先前几项关于侵袭性A组链球菌（GAS）疾病的研究因样本量小（≤100例患者）和普遍适用性有限而受到阻碍。
我们开展了一项基于人群的侵袭性GAS疾病研究。该研究的目的是描述因侵袭性GAS疾病住院的个体的临床特征，并确定医院死亡的危险因素。病例为4年期间在佛罗里达州各地住院并向佛罗里达州卫生部报告的257例患者。采用逻辑回归计算死亡率的调整比值比（OR）和95%置信区间（CI）。
总死亡率为18%（228例中的41例）。入住重症监护病房是死亡的有力预测因素（OR，20.41；95%CI，6.41 - 64.96）。克林霉素治疗可降低患有坏死性筋膜炎患者的死亡率（OR，0.11；95%CI，0.01 - 0.89），但对未患有坏死性筋膜炎的患者无效（OR，1.01；95%CI，0.31 - 3.33）。
克林霉素可降低患有坏死性筋膜炎的侵袭性GAS疾病患者的死亡率。
