Wahl R U, Lütticken R, Stanzel S, van der Linden M, Reinert R R
Department of Medical Microbiology, National Reference Center for Streptococci, RWTH Aachen University, Aachen, Germany.
Clin Microbiol Infect. 2007 Dec;13(12):1173-8. doi: 10.1111/j.1469-0691.2007.01821.x. Epub 2007 Sep 10.
A nationwide voluntary laboratory-based surveillance study of invasive Streptococcus pyogenes (group A streptococcus; GAS) infections was conducted in Germany between 1996 and 2002. Demographical and clinical information concerning the patients was obtained from the medical files. Multiple logistic regression analysis was used to determine risk-factors for fatal outcome. Invasive isolates were obtained from 475 patients, with 251 (52.8%) of the isolates cultured from blood. The most frequent emm types were emm1 (36.4%), emm28 (8.8%) and emm3 (8%). The speA, speC and ssa genes were present at variable frequencies in different emm types. The highest frequencies of speA and speC were found in emm1 (speA, 93.6%) and emm4 (speC, 94.7%), respectively. The estimated annual incidence of invasive GAS disease for 1997-2002 was 0.1 cases/100 000 individuals. This apparently low incidence rate might be explained by the voluntary nature of the surveillance system, resulting in relatively few cases being referred to the laboratory. Complete clinical information was available for 165 cases. The overall case fatality rate was 40.6%, and was highest (65.2%) in the group aged 60-69 years. Shock, an age of >or=30 years and adult respiratory distress syndrome were predictors of a fatal outcome in a multiple logistic regression analysis. Overall, 6.7% of the cases were considered to be nosocomial, and nine cases of puerperal sepsis were observed. The study underscores the importance of invasive S. pyogenes disease in Germany.
1996年至2002年期间，德国开展了一项基于实验室的全国性侵袭性化脓性链球菌（A组链球菌；GAS）感染自愿监测研究。有关患者的人口统计学和临床信息从病历中获取。采用多因素logistic回归分析确定死亡结局的危险因素。从475例患者中分离出侵袭性菌株，其中251株（52.8%）菌株培养自血液。最常见的emm型为emm1（36.4%）、emm28（8.8%）和emm3（8%）。speA、speC和ssa基因在不同的emm型中出现频率各异。speA和speC的最高频率分别在emm1（speA，93.6%）和emm4（speC，94.7%）中发现。1997 - 2002年侵袭性GAS疾病的估计年发病率为0.1例/10万人口。这一明显较低的发病率可能是由于监测系统的自愿性质，导致相对较少的病例被送往实验室。165例患者有完整的临床信息。总体病死率为40.6%，在60 - 69岁年龄组中最高（65.2%）。在多因素logistic回归分析中，休克、年龄≥30岁和成人呼吸窘迫综合征是死亡结局的预测因素。总体而言，6.7%的病例被认为是医院感染，观察到9例产褥期败血症。该研究强调了侵袭性化脓性链球菌疾病在德国的重要性。
