背景:大多数咽扁桃体炎指南侧重于A组链球菌(GAS)的鉴定,以临床评分为指导,确定使用快速抗原检测测试的测试对象。然而,许多试验阴性的患者被评估为C/G组链球菌(GCS/GGS)和坏死梭杆菌,然而,它们的重要性仍在争论中。我们的主要目的是评估并发症和坏死F.GAS,或咽喉炎中的GCS/GGS。
方法:这是一个回顾性研究,基于注册表的咽喉扁桃体炎病例研究,在Skáne地区测试了F.necrophorum(聚合酶链反应)和β-溶血性链球菌(培养),瑞典,2013-2020年。既往有并发症或抗生素(30天内)的患者被排除在外。数据是从登记册和电子图表中检索的。Logistic回归分析以并发症为主要结局,根据国际疾病分类,第十次修订,代码。结果阴性的病例(聚合酶链反应和培养)被设置为参考类别。30天内的并发症定义为扁桃体周围或咽部脓肿,中耳炎,鼻窦炎,败血症或败血症并发症,咽炎复发(15-30天后)或住院。
结果:在3700个登记病例中,28%患有F.坏死菌,13%有GCS/GGS,10%有气体,54%的结果为阴性。30天并发症发生率很高(20%)。F.坏死(赔率比,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呈负相关(0.7;0.4-0.98)。
结论:我们的结果表明,坏死F.而GCS/GGS测试的相关性受到质疑。然而,哪些患者需要检测和治疗坏死F.
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.