Blunt trauma as a risk factor for group A streptococcal necrotizing fasciitis
Blunt trauma as a risk factor for group A streptococcal necrotizing fasciitis
复制标题
DOI：
10.1016/j.annepidem.2007.05.011
复制
发表时间：
2007-11-01
影响因子：
5.6
通讯作者：
Mulla, Zuber D.
中科院分区：
文献类型：
--
作者：
Nuwayhid, Ziyad B.;Aronoff, David M.;Mulla, Zuber D.
目的：坊间报道表明，钝性创伤和看似无害的肌肉骨骼损伤(如肌肉拉伤)是由A组链球菌和其他细菌引起的坏死性筋膜炎和肌炎的危险因素；然而，这一假说尚未在侵袭性A组链球菌(GAS)的分析性流行病学研究中得到验证。我们进行了两项病例对照研究，以确定非穿透性创伤是否是神经纤维或由GAS引起的严重蜂窝组织炎的危险因素。方法：对佛罗里达州4年来因侵袭性气体疾病住院的患者进行了二次分析。使用两个病例系列。第一组包括患有严重胃蜂窝组织炎的患者。第二组为气性神经营养不良患者。病例-患者与由侵袭性气体疾病患者组成的单一对照序列进行比较，这些患者既不包括神经营养不良，也不包括蜂窝组织炎(例如，原发菌血症、感染性关节炎)。结果：在我们调整了饲料、种族和克林霉素的使用后，胃气性神经营养不良患者最近有钝性创伤史的可能性是对照组的5.97倍(p=0.04)。与对照组相比，重度蜂窝组织炎患者合并钝性损伤的可能性不大。结论：非穿透性损伤与气性神经营养不良的发生显著相关。
PURPOSE: Anecdotal reports suggest that blunt trauma and seemingly innocuous musculoskeletal injuries (e.g., muscle strains) are risk factors for developing necrotizing fasciitis (NF) and myositis caused by group A Streptococcus and other bacteria; however, this hypothesis has not been tested in analytic epidemiologic studies of invasive group A streptococcal (GAS) disease. We conducted two case-control studies to determine whether nonpenetrating trauma is a risk factor for either NF or severe cellulitis caused by GAS.METHODS: A secondary analysis of patients who were hospitalized throughout Florida for invasive GAS disease during a 4-year period was conducted. Two case series were used. The first series comprised patients who had severe GAS cellulitis. The second were patients who had GAS NF. Case-patients were compared to a single control series composed of patients with invasive GAS disease not including either NF or cellulitis (e.g., primary bacteremia, septic arthritis).RESULTS: After we adjusted forage, race, and clindamycin usage, GAS NF cases were 5.97 times as likely as controls to have a recent history of blunt trauma (p = 0.04). Patients with severe cellulitis were not more likely than controls to have associated blunt trauma.CONCLUSIONS: Nonpenetrating trauma is significantly associated with the development of GAS NF.