背景:A组链球菌是需要重症监护病房(ICU)入院的严重和潜在致命的侵入性疾病的原因,如链球菌中毒性休克样综合征(STSS)。在儿童中观察到COVID-19相关屏障措施后,侵袭性A组链球菌(iGAS)感染反弹。法国成人ICU的几位重症监护医师报告了类似的床头印象,但没有客观数据。我们的目的是比较COVID-19大流行前后iGAS感染的发生率,描述iGAS患者的特征,并确定ICU死亡率相关因素。
方法:我们在37个法国ICU中进行了一项回顾性多中心队列研究,包括所有因iGAS感染入院的患者,为期两个时期:两年前(2018年10月至2019年3月和2019年10月至2020年3月)和一年后(2022年10月至2023年3月)COVID-19大流行。iGAS感染定义为从正常无菌部位分离的A组链球菌。使用国际疾病分类鉴定了iGAS感染,并通过每个中心的微生物学实验室数据库进行了确认。iGAS感染的发生率以病例率表示。
结果:22例患者因iGAS感染入院ICU:COVID-19大流行前73例,后149例。在COVID-19大流行前后,他们的病例率为205和949/100,000ICU入院,分别(p<0.001),在COVID-19大流行后,STSS更加频繁(61%与45%,p=0.015)。iGAS患者(n=222)的中位SOFA评分为8(5-13),61%和74%的患者有创机械通气和去甲肾上腺素。iGAS患者的ICU死亡率为19%(COVID-19大流行前14%,COVID-19大流行后22%;p=0.135)。在多变量分析中,有创机械通气(OR=6.08(1.71-21.60),p=0.005),STSS(OR=5.75(1.71-19.22),p=0.005),急性肾损伤(OR=4.85(1.05-22.42),p=0.043),免疫抑制(OR=4.02(1.03-15.59),p=0.044),和糖尿病(OR=3.92(1.42-10.79),p=0.008)与ICU死亡率显著相关。
结论:COVID-19大流行后,需要入住ICU的iGAS感染发生率增加了4至5。在COVID-19大流行之后,STSS率较高,ICU死亡率没有显著增加。
Group A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients\' characteristics, and determine ICU mortality associated factors.
We performed a retrospective multicenter cohort
study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center\'s microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate.
Two hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively (p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients (n = 222) had a median SOFA score of 8 (5-13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71-21.60), p = 0.005), STSS (OR = 5.75 (1.71-19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05-22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03-15.59), p = 0.044), and diabetes (OR = 3.92 (1.42-10.79), p = 0.008) were significantly associated with ICU mortality.
The incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.