PDF(Pubmed)
Abstract：
Currently, it remains unclear why some children develop invasive group A Streptococcus (iGAS) and how to manage this condition. Therefore, to explore available works in the literature, we performed a scoping review aiming to analyze the current literature on clinical presentation of different illnesses outcomes of iGAS, with a specific focus on predictors of invasive infection, including an assessment of the prodromal stages of the disease and the possible presence of previous non-invasive GAS infections in children that later developed iGAS.
METHODS: We conducted a systematic search on PubMed and SCOPUS of all pediatric studies reporting iGAS cases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. For those studies in which multivariable analysis investigating iGAS risk factors was performed, a second review was performed and reported in detail.
RESULTS: A total of 209 studies were included. Five studies investigated risk factors for iGAS, the most relevant being varicella infection, chronic underlying illness, presence of the speC gene in GAS strains, acetaminophen and ibuprofen use, children nonwhite, living in low-income households, exposure to varicella at home, persistent high fever, having more than one other child in the home, and new use of NSAIDs. Although we observed a progressive increase in the number of papers published on this topic, no trials investigating the benefits of clindamycin or intravenous immunoglobulins were found and low-to-middle-income countries were found to be poorly represented in the current literature.
CONCLUSIONS: Our scoping review highlights important gaps regarding several aspects of iGAS in children, including prodromic presentation and optimal treatment strategies. There is also little representation of low-middle-income countries. The current literature does not allow the performance of systematic reviews or meta-analyses, but this work should inform healthcare professionals, policy makers, and funding agencies on which studies to prioritize on this topic.
METHODS: We conducted a systematic search on PubMed and SCOPUS of all pediatric studies reporting iGAS cases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. For those studies in which multivariable analysis investigating iGAS risk factors was performed, a second review was performed and reported in detail.
RESULTS: A total of 209 studies were included. Five studies investigated risk factors for iGAS, the most relevant being varicella infection, chronic underlying illness, presence of the speC gene in GAS strains, acetaminophen and ibuprofen use, children nonwhite, living in low-income households, exposure to varicella at home, persistent high fever, having more than one other child in the home, and new use of NSAIDs. Although we observed a progressive increase in the number of papers published on this topic, no trials investigating the benefits of clindamycin or intravenous immunoglobulins were found and low-to-middle-income countries were found to be poorly represented in the current literature.
CONCLUSIONS: Our scoping review highlights important gaps regarding several aspects of iGAS in children, including prodromic presentation and optimal treatment strategies. There is also little representation of low-middle-income countries. The current literature does not allow the performance of systematic reviews or meta-analyses, but this work should inform healthcare professionals, policy makers, and funding agencies on which studies to prioritize on this topic.
摘要：
目前,目前尚不清楚为什么一些儿童会出现侵袭性A族链球菌(iGAS),以及如何控制这种情况.因此,为了探索文献中可用的作品，我们进行了范围审查，旨在分析当前有关iGAS不同疾病结局的临床表现的文献，特别关注侵袭性感染的预测因素，包括对疾病前驱阶段的评估，以及后来发展为iGAS的儿童可能存在的先前非侵入性GAS感染。
方法：我们对PubMed和SCOPUS进行了系统的检索，检索所有报告iGAS病例的儿科研究，遵循系统审查和Meta分析扩展的首选报告项目，用于范围审查(PRISMA-ScR)清单。对于进行多变量分析调查iGAS危险因素的研究，我们进行了第二次审查并详细报告.
结果：共纳入209项研究。五项研究调查了iGAS的危险因素，最相关的是水痘感染，慢性基础疾病，在GAS菌株中存在speC基因，对乙酰氨基酚和布洛芬的使用，非白人儿童,生活在低收入家庭，在家接触水痘,持续高烧,家里有不止一个孩子，和NSAIDs的新用途。尽管我们观察到有关该主题的论文数量逐渐增加，没有发现调查克林霉素或静脉注射免疫球蛋白获益的试验,并且发现中低收入国家在现有文献中的代表性不足.
结论：我们的范围审查强调了儿童iGAS几个方面的重要差距，包括前驱表现和最佳治疗策略。中低收入国家的代表也很少。目前的文献不允许进行系统评价或荟萃分析，但是这项工作应该告知医疗保健专业人员，政策制定者,和资助机构的研究优先考虑这一主题。
方法：我们对PubMed和SCOPUS进行了系统的检索，检索所有报告iGAS病例的儿科研究，遵循系统审查和Meta分析扩展的首选报告项目，用于范围审查(PRISMA-ScR)清单。对于进行多变量分析调查iGAS危险因素的研究，我们进行了第二次审查并详细报告.
结果：共纳入209项研究。五项研究调查了iGAS的危险因素，最相关的是水痘感染，慢性基础疾病，在GAS菌株中存在speC基因，对乙酰氨基酚和布洛芬的使用，非白人儿童,生活在低收入家庭，在家接触水痘,持续高烧,家里有不止一个孩子，和NSAIDs的新用途。尽管我们观察到有关该主题的论文数量逐渐增加，没有发现调查克林霉素或静脉注射免疫球蛋白获益的试验,并且发现中低收入国家在现有文献中的代表性不足.
结论：我们的范围审查强调了儿童iGAS几个方面的重要差距，包括前驱表现和最佳治疗策略。中低收入国家的代表也很少。目前的文献不允许进行系统评价或荟萃分析，但是这项工作应该告知医疗保健专业人员，政策制定者,和资助机构的研究优先考虑这一主题。
