Suárez-Arrabal María Carmen, Sánchez Cámara Luis Alberto, Navarro Gómez María Luisa, Santos Sebastián María Del Mar, Hernández-Sampelayo Teresa, Cercenado Mansilla Emilia, Saavedra-Lozano Jesús
Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
An Pediatr (Engl Ed). 2019 Nov;91(5):286-295. doi: 10.1016/j.anpedi.2018.12.017. Epub 2019 Mar 2.
Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years.
To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity.
A retrospective study was conducted on children≤16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity.
The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/10 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P=.057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P=.116), had a higher C-reactive protein (24.5 vs 10.7mg/dl, P<.001) and higher frequency of pneumonia (60 vs 7%, P<.001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P=.04). There were no sequelae.
An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series.
侵袭性A组链球菌病（iGASD）是儿童的一种严重感染。多项研究表明在过去几年中其发病率有所上升。
评估儿童iGASD的特征和转归，并确定发病率或严重程度的变化。
对在马德里一家三级儿科医院接受评估且诊断为iGASD（2005年6月至2013年7月）的16岁及以下儿童进行回顾性研究。对人口统计学、症状学、微生物学和治疗进行分析。评估研究期间的变化以及与疾病严重程度相关的参数。
该研究共纳入55例iGASD患儿，其中33例（60%）为女性，中位年龄为48.5（20.5 - 88.9）个月。最常见的临床综合征为蜂窝织炎/皮下脓肿（21.8%）、耳鼻喉脓肿（20%）、肺炎（16.4%）、骨关节炎感染（16.4%）和乳突炎（12.7%）。iGASD的发病率（病例数/10次急诊/年）从2005年6月至2009年5月的5.6（4.2 - 7.2）增至2009年6月至2013年5月的18.9（15.1 - 26）；P = 0.057。分别有35例（63.6%）和10例（18.2%）患者需要手术及入住儿科重症监护病房（PICU）。入住PICU的儿童年龄更小（26.5个月对52.6个月，P = 0.116），C反应蛋白水平更高（24.5mg/dl对10.7mg/dl，P < 0.001），肺炎发生率更高（60%对7%，P < 0.001）。在多因素分析中，只有C反应蛋白是入住PICU的危险因素（比值比：1.14 [1.004 - 1.286]，P = 0.04）。无后遗症。
本研究中观察到儿童iGASD发病率增加。在本系列研究中，年龄较小、肺炎及较高的C反应蛋白与疾病严重程度相关。
