Nuwayhid Ziyad B, Aronoff David M, Mulla Zuber D
Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, and Department of Biological Sciences, University of Texas at El Paso, El Paso, Texas 79905, USA.
Ann Epidemiol. 2007 Nov;17(11):878-81. doi: 10.1016/j.annepidem.2007.05.011. Epub 2007 Aug 13.
Anecdotal reports suggest that blunt trauma and seemingly innocuous musculoskeletal injuries (e.g., muscle strains) are risk factors for developing necrotizing fasciitis (NF) and myositis caused by group A Streptococcus and other bacteria; however, this hypothesis has not been tested in analytic epidemiologic studies of invasive group A streptococcal (GAS) disease. We conducted two case-control studies to determine whether nonpenetrating trauma is a risk factor for either NF or severe cellulitis caused by GAS.
A secondary analysis of patients who were hospitalized throughout Florida for invasive GAS disease during a 4-year period was conducted. Two case series were used. The first series comprised patients who had severe GAS cellulitis. The second were patients who had GAS NF. Case-patients were compared to a single control series composed of patients with invasive GAS disease not including either NF or cellulitis (e.g., primary bacteremia, septic arthritis).
After we adjusted for age, race, and clindamycin usage, GAS NF cases were 5.97 times as likely as controls to have a recent history of blunt trauma (p = 0.04). Patients with severe cellulitis were not more likely than controls to have associated blunt trauma.
Nonpenetrating trauma is significantly associated with the development of GAS NF.
轶事报告表明，钝性创伤和看似无害的肌肉骨骼损伤（如肌肉拉伤）是由A组链球菌和其他细菌引起的坏死性筋膜炎（NF）和肌炎的危险因素；然而，这一假设尚未在侵袭性A组链球菌（GAS）疾病的分析性流行病学研究中得到验证。我们进行了两项病例对照研究，以确定非穿透性创伤是否是GAS引起的NF或严重蜂窝织炎的危险因素。
对佛罗里达州4年内因侵袭性GAS疾病住院的患者进行了二次分析。使用了两个病例系列。第一个系列包括患有严重GAS蜂窝织炎的患者。第二个系列是患有GAS NF的患者。将病例患者与由不包括NF或蜂窝织炎的侵袭性GAS疾病患者（如原发性菌血症、脓毒性关节炎）组成的单一对照系列进行比较。
在对年龄、种族和克林霉素使用情况进行调整后，GAS NF病例近期有钝性创伤史的可能性是对照组的5.97倍（p = 0.04）。严重蜂窝织炎患者与对照组相比，发生相关钝性创伤的可能性并不更高。
非穿透性创伤与GAS NF的发生显著相关。
