Trends in bacteremic infection due to Streptococcus pyogenes (group A streptococcus), 1986-1995.
Trends in bacteremic infection due to Streptococcus pyogenes (group A streptococcus), 1986-1995.
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1986 年至 1995 年，化脓性链球菌（A 组链球菌）引起的菌血症感染趋势。
DOI：
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发表时间：
1996
影响因子：
11.8
通讯作者：
C. Ashton
中科院分区：
文献类型：
--
作者：
D. M. Musher;R. Hamill;C. Wright;J. Clarridge;C. Ashton
在过去7年中，化脓性链球菌（A组链球菌[GAS]）引起的严重侵袭性感染的报告频率越来越高（1）。目前尚不确定这些报告是否反映了这种致病细菌引起的疾病发病率的实际增加，或者仅仅是医学界的认识和兴趣有所提高。无论是在一个地区（2）、一个省（3）或在离散的暴发（4、5）中描述威胁生命的感染的明显复发，这种困难都普遍存在，并且由于链球菌感染在大多数地区不是可报告的疾病而加剧。感染的爆发可能会唤醒人们对链球菌病的兴趣，导致发表偏倚（6，7）。持续的研究可能表明，GAS感染发病率的普遍增加可能实际上代表了一种爆发，正如科罗拉多（8，9）、瑞典（10）和英国（11）所证明的那样。在一项基于实验室的研究中，Burkert和Watanakunakorn（12）发现，由于S。化脓性链球菌在1980年至1989年没有变化。亚利桑那州皮马县进行的一项细致的、基于人群的研究（13）发现，1985年至1990年间，侵袭性GAS疾病的发病率没有变化，但根据出现的情况，确实表明链球菌中毒性休克综合征在20世纪80年代末出现。1987 - 1990年有6例此类病例，而1985-1987年为零例。相比之下，以色列的一份基于人口的初步报告（14）没有发现这种增加。休斯顿退伍军人事务医疗中心（HVAMC）为大约50，000名符合条件的退伍军人提供服务，大多数在德克萨斯州哈里斯县和周边县，尽管这些退伍军人中有一小部分住在德克萨斯州其他地方或接壤的州。大多数患者为中年或老年男性，但约20%的患者年龄在40岁以下。在过去的十年里，我们的一些病人，特别是那些贫困和/或老年人，有更广泛的医疗选择，而其他人，特别是那些医疗保险最初是边缘的人，有更窄的选择。然而，大多数选择HVAMC治疗任何问题的人倾向于认同这个医疗中心，并期待它提供完整的医疗服务（15）。与美国一些医学中心的报道相反，我们的临床经验并没有表明由S。化脓性链球菌在过去十年中有所增加。由于我们的人口相对稳定，并且我们的微生物学实验室有1986年至1995年的数据，我们研究了这一时期医疗中心菌血症感染的趋势。在研究的9年中，HVAMC的年度住院人数下降了4.1%，而门诊人数增加了33.9%。在某一年，到该中心就医的病人人数（由社会保险号码决定）增加了18.7%，入院人数减少了5.2%，门诊人数增加了19.4%。在此期间，每年提交用于培养的血液样本数量基本保持不变。我们注意到临床结果没有变化，提示实习医生和住院医生要求血培养，尽管不能排除未被识别的细微变化的可能性。1986年至1995年期间，从血培养（图1）或所有无菌部位（数据未显示）分离GAS的比率保持不变。阳性血培养的数量在夏季和初秋往往较低，在仲冬上升，但在整个十年中，平均数量保持在每年约5至8例。在观察的十年期间，从所有标本中分离GAS的频率显著下降（p = 0.003）。这些数据表明，由于S。化脓性链球菌在居住在德克萨斯州休斯顿及其周边地区的退伍军人中没有增加。S.从血液和所有无菌场所感染化脓性链球菌的人数保持不变，而接受住院和门诊治疗的人数实际上有所增加。来自所有来源的分离株总数轻微但显著减少，这可能表明，
During the past 7 years, severe invasive infections caused by Streptococcus pyogenes (group A streptococcus [GAS]) have been reported with increasing frequency (1). It is not certain whether these reports reflect actual increase in the incidence of disease caused by this pathogenic bacterium or merely enhanced awareness and interest on the part of the medical community. This difficulty prevails whether the apparent resurgence of life-threatening infection is described within a region (2), a province (3), or in discrete outbreaks (4,5) and is heightened by the fact that streptococcal infection has not been a reportable disease in most locales. An outbreak of infection may awaken interest in streptococcal disease, leading to publication bias (6,7). Continued study may show that what appears to be a general increase in the incidence of GAS infection may actually represent an outbreak, as has been demonstrated in Colorado (8,9), Sweden (10), and the United Kingdom (11). In a laboratory-based study, Burkert and Watanakunakorn (12) found that the frequency and apparent severity of bacteremic infection due to S. pyogenes did not change from 1980 to 1989. A meticulous, population-based study in Pima County, Arizona (13), found no change in the incidence of invasive GAS disease between 1985 and 1990 but did suggest the emergence of streptococcal toxic shock syndrome in the late 1980s, on the basis of the appearance of six such cases in 19871990 compared to zero cases in 1985-1987. In contrast, a preliminary, population-based report from Israel (14) found no such increase. The Houston Veterans Affairs Medical Center (HVAMC) serves about 50,000 eligible veterans, most in Harris County, Texas, and surrounding counties, although a small number of these veterans live elsewhere in Texas or in bordering states. Most patients are middle-aged or elderly men, although approximately 20% are under the age of 40. Within the past decade, there have been broader medical options for some of our patients, especially those who are indigent and/or elderly, and narrower options for others, especially those whose medical insurance was initially marginal. Nevertheless, most persons who select the HVAMC for care of any problem tend to identify themselves with this medical center and look to it to provide complete medical care (15). In contrast to that reported by some medical centers in the United States, our clinical experience did not suggest that the number or severity of infections due to S. pyogenes had increased during the past decade. Because our population was relatively stable and data were available in our Microbiology Laboratory for 1986 through 1995, we studied trends in bacteremic infection at the medical center during this period. In the 9 years under study, the number of yearly inpatient admissions to the HVAMC decreased by 4.1%, while the number of outpatient visits increased by 33.9%. The number of patients who, in a given year, sought medical attention at the center (determined by social security numbers), increased by 18.7%, with a 5.2% decrease in those persons admitted to the hospital and a 19.4% increase in those who sought outpatient care. During this period, the number of blood specimens submitted for cultures each year remained essentially unchanged. We have noted no change in the clinical findings that prompt interns and residents to request blood cultures, although the possibility of unrecognized, subtle changes cannot be excluded. The rate of isolation of GAS from blood cultures (Figure 1) or from all sterile sites (data not shown) remained unchanged between 1986 and 1995. The number of positive blood cultures tended to be lower in the summer and early fall and to rise in midwinter, but the average number has remained at approximately five to eight per year during the entire decade. The frequency with which GAS were isolated from all specimens declined significantly (p = 0.003) during the decade under observation. These data suggest that the frequency of bacteremic infection due to S. pyogenes has not increased in a population of veterans residing in and around Houston, Texas. The number of isolates of S. pyogenes from blood and from all sterile sites has remained unchanged, whereas the number of persons served in inpatient and outpatient encounters actually increased. The slight, but significant decrease in the total number of isolates from all sources might suggest that an Dispatches
细菌性疾病频率的时间变化：渥太华和德国东部猩红热流行的分子群体遗传分析。
DOI：
10.1093/infdis/167.3.759
发表时间：
1993
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Musser,JM;Nelson,K;Selander,RK;Gerlach,D;Huang,JC;Kapur,V;Kanjilal,S
通讯作者：
Kanjilal,S
表达热原性外毒素 A（猩红热毒素）等位基因变体的两个高致病性化脓性链球菌克隆的地理和时间分布及分子特征。
DOI：
10.1093/infdis/167.2.337
发表时间：
1993
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Musser,JM;Kapur,V;Kanjilal,S;Shah,U;Musher,DM;Barg,NL;Johnston,KH;Schlievert,PM;Henrichsen,J;Gerlach,D
通讯作者：
Gerlach,D