Division of Infection Medicine, Lund University, Lund, Sweden.
Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden.
Clin Infect Dis. 2023 Feb 8;76(3):e1428-e1435. doi: 10.1093/cid/ciac736.
Most pharyngotonsillitis guidelines focus on the identification of group A streptococci (GAS), guided by clinical scores determining whom to test with a rapid antigen detection test. Nevertheless, many patients testing negative with this test are evaluated for group C/G streptococci (GCS/GGS) and Fusobacterium necrophorum, yet their importance remains debated. Our primary aim was to evaluate associations between complications and findings of F. necrophorum, GAS, or GCS/GGS in pharyngotonsillitis.
This was a retrospective, registry-based study of pharyngotonsillitis cases tested for F. necrophorum (polymerase chain reaction) and β-hemolytic streptococci (culture) in the Skåne Region, Sweden, in 2013-2020. Patients with prior complications or antibiotics (within 30 days) were excluded. Data were retrieved from registries and electronic charts. Logistic regression analyses were performed with a dichotomous composite outcome of complications as primary outcome, based on International Classification of Diseases, Tenth Revision, codes. Cases with negative results (polymerase chain reaction and culture) were set as reference category. Complications within 30 days were defined as peritonsillar or pharyngeal abscess, otitis, sinusitis, sepsis or septic complications, recurrence of pharyngotonsillitis (after 15-30 days) or hospitalization.
Of 3700 registered cases, 28% had F. necrophorum, 13% had GCS/GGS, 10% had GAS, and 54% had negative results. The 30-day complication rates were high (20%). F. necrophorum (odds ratio, 1.8; 95% confidence interval, 1.5-2.1) and GAS (1.9; 1.5-2.5) were positively associated with complications, whereas GCS/GGS were negatively associated (0.7; 0.4-0.98).
Our results indicate that F. necrophorum is a relevant pathogen in pharyngotonsillitis, whereas the relevance of testing for GCS/GGS is questioned. However, which patient to test and treat for F. necrophorum remains to be defined.
大多数咽扁桃体炎指南都侧重于鉴定 A 组链球菌（GAS），通过临床评分来确定哪些患者需要进行快速抗原检测。然而，许多检测结果为阴性的患者会进一步检测 C/G 组链球菌（GCS/GGS）和坏死梭杆菌，但其重要性仍存在争议。我们的主要目的是评估咽扁桃体炎中坏死梭杆菌、GAS 或 GCS/GGS 与并发症之间的关系。
这是一项在瑞典斯科讷地区 2013 年至 2020 年进行的基于病例的回顾性研究，对接受坏死梭杆菌（聚合酶链反应）和β-溶血性链球菌（培养）检测的咽扁桃体炎患者进行了研究。排除有既往并发症或在 30 天内使用抗生素的患者。数据从登记处和电子病历中提取。根据国际疾病分类第十版（ICD-10）的编码，将并发症作为主要结局，采用二元复合结局的逻辑回归分析。将检测结果为阴性（聚合酶链反应和培养）的患者设为参考组。30 天内的并发症定义为扁桃体周围脓肿或咽后脓肿、中耳炎、鼻窦炎、脓毒症或脓毒症并发症、咽扁桃体炎复发（15-30 天后）或住院治疗。
在登记的 3700 例患者中，28%有坏死梭杆菌感染，13%有 GCS/GGS 感染，10%有 GAS 感染，54%检测结果为阴性。30 天内的并发症发生率较高（20%）。坏死梭杆菌（比值比，1.8；95%置信区间，1.5-2.1）和 GAS（1.9；1.5-2.5）与并发症呈正相关，而 GCS/GGS 则呈负相关（0.7；0.4-0.98）。
我们的结果表明，坏死梭杆菌是咽扁桃体炎的一种相关病原体，而检测 GCS/GGS 的相关性仍存在争议。然而，仍需明确应检测和治疗哪些患者的坏死梭杆菌。
