Epprecht Gioia, Weller David, Hofmaenner Daniel A, Andrianaki Angeliki M, Frey Pascal M, Brugger Silvio D, Zinkernagel Annelies S
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Open Forum Infect Dis. 2024 Oct 10;11(10):ofae572. doi: 10.1093/ofid/ofae572. eCollection 2024 Oct.
Necrotizing soft tissue infections (NSTIs) are often caused by group A (GAS). As the number of invasive GAS infections decreased during the coronavirus disease 2019 (COVID-19) pandemic restrictions, this study aimed to compare the occurrence of GAS-NSTIs before, during, and after the COVID-19 pandemic restrictions.
This retrospective cohort study included adult patients with NSTIs admitted to the intensive care unit (ICU) of the University Hospital Zurich, Switzerland, from July 2008 to December 2023. NSTI cases were categorized as pre-, during, and postrestrictions. The primary outcome was the proportion of GAS in NSTI, and the exploratory secondary outcome was in-hospital death. A data analysis was conducted using Firth logistic regression adjusted for age, sex, diabetes, and initially affected body region.
Overall, 74 NSTI cases were identified, with 49 occurring before, 8 during, and 17 after the pandemic restrictions. GAS was isolated in 27 (36%) cases, with 17 (35%) pre- and 10 (59%) postrestrictions, but none during the restrictions. NSTIs caused by other bacteria persisted during the restrictions. The odds of GAS were significantly lower during the restrictions (adjusted odds ratio, 0.02; 95% CI, 0.001-0.81) compared with after, while no significant differences were found between the pre- and postrestriction periods.
The significant decrease of GAS-NSTIs during the COVID-19 pandemic restrictions suggests that isolation measures may have prevented the transmission of GAS, resulting in a decline of GAS-NSTIs while NSTIs caused by bacteria transmitted by alternative routes persisted.
坏死性软组织感染（NSTIs）通常由A组链球菌（GAS）引起。由于在2019年冠状病毒病（COVID-19）大流行限制期间侵袭性GAS感染的数量有所下降，本研究旨在比较COVID-19大流行限制之前、期间和之后GAS-NSTIs的发生率。
这项回顾性队列研究纳入了2008年7月至2023年12月在瑞士苏黎世大学医院重症监护病房（ICU）住院的成年NSTIs患者。NSTI病例分为限制前、限制期间和限制后。主要结局是NSTI中GAS的比例，探索性次要结局是住院死亡。使用经年龄、性别、糖尿病和最初受影响身体部位调整的Firth逻辑回归进行数据分析。
总体而言，共识别出74例NSTI病例，其中49例发生在大流行限制之前，8例发生在限制期间，17例发生在限制之后。在27例（36%）病例中分离出GAS，其中17例（35%）在限制前，10例（59%）在限制后，但在限制期间未分离出。由其他细菌引起的NSTIs在限制期间持续存在。与限制后相比，限制期间GAS的发生率显著降低（调整后的优势比为0.02；95%置信区间为0.001-0.81），而限制前和限制后期间未发现显著差异。
COVID-19大流行限制期间GAS-NSTIs的显著减少表明，隔离措施可能预防了GAS的传播，导致GAS-NSTIs下降，而由其他传播途径传播的细菌引起的NSTIs持续存在。
