Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Department of Pediatrics, Maasstad Hospital, Rotterdam, the Netherlands.
Eur J Pediatr. 2023 Feb;182(2):697-706. doi: 10.1007/s00431-022-04718-y. Epub 2022 Nov 30.
Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections (p < 0.001); and were younger (median 40 (IQR 21-83) vs 56 (IQR 36-85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring (p < 0.001).
In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short- and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease.
• Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited.
• In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients.
全球范围内 A 组链球菌（GAS）疾病的发病率不断上升。我们对欧洲医院收治的 GAS 感染患儿进行了特征描述，并研究了严重程度和残疾的危险因素。这是一项前瞻性、多中心队列研究（嵌入 EUCLIDS 和瑞士儿科脓毒症研究中），纳入了 2012 年至 2016 年间来自欧洲 6 个国家 41 家医院的 320 名年龄在 1 个月至 18 岁之间、因 GAS 感染住院的儿童。收集了人口统计学、临床、微生物学和结局数据。共有 195 名（61%）患者发生脓毒症。236 名（74%）患者从正常无菌部位检测到 GAS。最常见的感染部位是下呼吸道（LRTI）（22%）、皮肤和软组织（SSTI）（23%）和骨和关节（19%）。与未入住 PICU 的患者相比，入住 PICU 的患者更常出现 LRTI（39%比 8%）、无明确病灶的感染（22%比 8%）和颅内感染（9%比 3%）；较少出现 SSTI 和骨与关节感染（p<0.001）；且年龄更小（中位数 40（IQR 21-83）比 56（IQR 36-85）个月，p=0.01）。6 名 PICU 患者（2%）死亡。出院时的后遗症主要局限于入住 PICU 的患者（29%比 3%，p<0.001；总体为 12%），包括神经残疾、截肢、植皮、听力损失和需要手术。更多的患者在冬季和春季被招募（p<0.001）。
在观察到疫苗可预防感染明显减少的时代，需要住院治疗的 GAS 感染仍与年幼儿童的严重疾病以及短期和长期发病率相关。需要在 GAS 疾病的预防和早期识别方面取得进一步进展。
•尽管存在时间和地域差异，但 A 组链球菌感染的发病率仍在上升。然而，关于欧洲儿童 A 组链球菌感染的流行病学数据有限。
•在一项针对欧洲需要住院治疗的社区获得性细菌性感染的大型前瞻性队列研究中，GAS 是最常见的病原体，29%的 GAS 感染患者出院时存在残疾，2%的患者死亡。•在 GAS 败血症患儿中，IVIG 的使用率仅为 4.6%，克林霉素的使用率为 29%。
