Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis.
Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(21)00672-1
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发表时间：
2022-07
影响因子：
56.3
通讯作者：
Seale, Anna C.
中科院分区：
文献类型：
--
作者：
Sherwood, Emma;Vergnano, Stefania;Kakuchi, Isona;Bruce, Michael G.;Chaurasia, Suman;David, Samara;Dramowski, Angela;Georges, Scarlett;Guy, Rebecca;Lamagni, Theresa;Levy-Bruhl, Daniel;Lyytikainen, Outi;Naus, Monika;Okaro, Jennifer Onukwube;Oppegaard, Oddvar;Vestrheim, Didrik F.;Zulz, Tammy;Steer, Andrew C.;Van Beneden, Chris A.;Seale, Anna C.
在过去的15年中，由A组链球菌（GAS）引起的侵袭性疾病的发病率在多个国家有所增加。然而，尽管有这些报告，据我们所知，在关键的高危人群中，没有对侵袭性GAS的发生率进行系统评价和综合估计。为了解决这个问题，我们估计了两个高危人群（即孕妇和5岁以下儿童）中侵袭性GAS疾病的发病率，包括死亡和残疾结局。我们对全球和各收入地区的孕妇、新生儿（小于28天）、婴儿（小于1岁）和儿童（小于5岁）的侵入性GAS结局进行了系统回顾和荟萃分析，包括发病率、病死率风险和神经发育障碍风险。我们在几个数据库中检索了2000年1月1日至2020年6月3日发表的文章，以及报告侵入性GAS结局的出版物，并从合作者研究小组中寻找未发表的数据。我们纳入了关于侵袭性GAS病例数据的研究，定义为实验室从任何正常无菌部位分离出化脓性链球菌，或从坏死性筋膜炎或链球菌中毒性休克综合征患者的非无菌部位分离出化脓性链球菌。为了纳入汇总发生率估计值，研究必须报告人群分母，为了纳入病例死亡风险的汇总估计值，研究必须报告关注结局的汇总数据和作为分母纳入的病例总数。我们排除了关注极高风险人群（例如，仅早产儿）的研究。我们用I2评估异质性。在950篇已发表的文章和29个未发表的数据集中，来自12个国家的20项研究（7项未发表; 3829例侵入性GAS）提供了足够的数据，可纳入汇总的结局估计值。我们没有发现报告低收入和中等收入国家（LMIC）孕妇中侵入性GAS发生率的研究，也没有发现任何报告LMIC中侵入性GAS后神经发育受损的研究。在来自高收入国家（HIC）的9项研究中，报告了妊娠期和产后期间的侵入性GAS，侵入性GAS发生率为0.12/1000例活产（95%CI 0.11至0.14; I2=100%）。侵袭性GAS发生率为0.04/1000活产（0.03至0.05; I2=100%; 11项研究）新生儿，每1000例活产0.13例（0·10至0·16; I2=100%; 10项研究），婴儿为0·09/1000人-年（95% CI 0.07至0.10; I2=100%; 9项研究）全球儿童;每1000例活产婴儿中有0.12例（95% CI 0.00至0.24; I2=100%; 3项研究）新生儿中，每1000例活产中有0.33例（-0.22至0.88; I2=100%;两项研究），每1000人-年为0.22（0.13至0.31; I2=100%;两项研究）;每1000例活产0.02例（0.00至0.03; I2=100%; 8项研究）新生儿，每1000例活产0·08例（0.05至0.11; I2=100%; 8项研究），儿童中HIC为0.05/1000人-年（0.03至0.06; I2=100%; 7项研究）。病死率风险较高，特别是在中低收入国家的新生儿中（61% [95% CI 33 - 89]; I2=54%; 2项研究）。我们发现在幼儿中有大量的侵入性GAS负担。在中低收入国家，新生儿和儿童的数据很少，孕妇的数据也没有。侵袭性GAS的发生率可能被低估，特别是在中低收入国家，由于低GAS监测。必须改善现有数据，为制定侵入性GAS的预防和管理策略提供信息。Wellcome Trust.
The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups—namely, pregnant women and children younger than 5 years. We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I2. Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income and middle-income countries (LMICs) nor any reporting neurodevelopmental impairment after invasive GAS in LMICs. In nine studies from high-income countries (HICs) that reported invasive GAS in pregnancy and the post-partum period, invasive GAS incidence was 0·12 per 1000 livebirths (95% CI 0·11 to 0·14; I2=100%). Invasive GAS incidence was 0·04 per 1000 livebirths (0·03 to 0·05; I2=100%; 11 studies) for neonates, 0·13 per 1000 livebirths (0·10 to 0·16; I2=100%; ten studies) for infants, and 0·09 per 1000 person-years (95% CI 0·07 to 0·10; I2=100%; nine studies) for children worldwide; 0·12 per 1000 livebirths (95% CI 0·00 to 0·24; I2=100%; three studies) in neonates, 0·33 per 1000 livebirths (−0·22 to 0·88; I2=100%; two studies) in infants, and 0·22 per 1000 person-years (0·13 to 0·31; I2=100%; two studies) in children in LMICs; and 0·02 per 1000 livebirths (0·00 to 0·03; I2=100%; eight studies) in neonates, 0·08 per 1000 livebirths (0·05 to 0·11; I2=100%; eight studies) in infants, and 0·05 per 1000 person-years (0·03 to 0·06; I2=100%; seven studies) in children for HICs. Case fatality risks were high, particularly among neonates in LMICs (61% [95% CI 33 to 89]; I2=54%; two studies). We found a substantial burden of invasive GAS among young children. In LMICs, little data were available for neonates and children and no data were available for pregnant women. Incidences of invasive GAS are likely to be underestimates, particularly in LMICs, due to low GAS surveillance. It is essential to improve available data to inform development of prevention and management strategies for invasive GAS. Wellcome Trust.