美国疾病控制和预防中心Stephanie J. Schrag课题组在研究中取得进展。他们的最新研究提出了美国10个州的侵袭性A群链球菌感染。2025年4月7日，国际知名学术期刊《美国医学会杂志》发表了这一成果。

重要性：侵袭性A群链球菌（GAS）感染与大量发病率、死亡率和经济负担有关。

目的：更新2013年至2022年美国10个州侵袭性GAS发病率的趋势。

设计、设置和参与者：侵袭性GAS病例的临床、人口统计学和实验室数据被收集，作为活跃细菌核心监测网络中基于人群的监测的一部分，该网络覆盖了美国10个州的3490万人。病例定义为2013年1月1日至2022年12月31日期间，从坏死性筋膜炎或链球菌中毒性休克综合征患者的正常无菌部位或伤口分离出GAS。人口统计和临床数据收集自病历回顾。2013 - 2014年可用分离株为emm型，采用常规方法检测药物敏感性；从2015年开始，使用全基因组测序。

主要成果和措施：按性别、年龄、种族和选定危险因素分列的发病率；临床综合征、结果和潜在的患者状况；并且分离物的特性，包括抗菌敏感性。

结果：美国10个州的监测发现了21从2013年到2022年有312例侵入性GAS，包括1981例死亡。男性占多数（57.5%）。病例中，年龄0 ~ 17岁1272例（6.0%）；18 ~ 64岁565例（63.7%），65岁及以上6474例（30.4%）；5.5%为美洲印第安人或阿拉斯加原住民，14.3%为黑人，67.1%为白人。发病率从3.6 / 100从2013年的每100人增加8.2人到2022年将有1000人（P<.001代表趋势)。65岁及以上人群发病率最高；然而，随着时间的推移，18至64岁的成年人的相对增幅最大（每10万人3.2至8.7人）。美国印第安人或阿拉斯加土著人的发病率高于其他种族和族裔群体。无家可归者、注射吸毒者和长期护理机构的居民的GAS发病率显著升高。对大环内酯类和克林霉素不敏感的分离株从2013年的12.7%上升到2022年的33.1%。

结论：在2013年至2022年的监测期间，美国10个州的侵袭性GAS感染大幅增加。需要加快努力预防和控制毒气，特别是在感染风险最高的人群中。

附：英文原文

Title: Invasive Group A Streptococcal Infections in 10 US States

Author: Christopher J. Gregory, Jennifer Onukwube Okaro, Arthur Reingold, Shua Chai, Rachel Herlihy, Susan Petit, Monica M. Farley, Lee H. Harrison, Kathy Como-Sabetti, Ruth Lynfield, Paula Snippes Vagnone, Daniel Sosin, Bridget J. Anderson, Kari Burzlaff, Tasha Martin, Ann Thomas, William Schaffner, H. Keipp Talbot, Bernard Beall, Sopio Chochua, Yunmi Chung, Soyoun Park, Chris Van Beneden, Yuan Li, Stephanie J. Schrag

Issue&Volume: 2025-04-07

Abstract: Importance  Invasive group A Streptococcus (GAS) infections are associated with substantial morbidity, mortality, and economic burden.

Objective  To update trends in invasive GAS disease incidence rates in 10 US states between 2013 and 2022.

Design, Setting, and Participants  Clinical, demographic, and laboratory data for invasive GAS cases were collected as part of population-based surveillance in the Active Bacterial Core surveillance network covering 34.9 million persons across 10 US states. A case was defined as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome between January 1, 2013, and December 31, 2022. Demographic and clinical data were collected from medical record review. From 2013 to 2014, available isolates were emm typed and antimicrobial susceptibilities determined using conventional methods; from 2015 onward, whole-genome sequencing was used.

Main Outcomes and Measures  Incidence rates by sex, age, race, and selected risk factors; clinical syndromes, outcomes, and underlying patient conditions; and isolate characteristics, including antimicrobial susceptibility.

Results  Surveillance in 10 US states identified 21312 cases of invasive GAS from 2013 through 2022, including 1981 deaths. The majority of cases (57.5%) were in males. Among case-patients, 1272 (6.0%) were aged 0 to 17 years, 13565 (63.7%) were aged 18 to 64 years, and 6474 (30.4%) were 65 years or older; 5.5% were American Indian or Alaska Native, 14.3% were Black, and 67.1% were White. Incidence rose from 3.6 per 100000 persons in 2013 to 8.2 per 100000 persons in 2022 (P<.001 for trend). Incidence was highest among persons 65 years or older; however, the relative increase over time was greatest among adults aged 18 to 64 years (3.2 to 8.7 per 100000 persons). Incidence was higher among American Indian or Alaska Native persons than in other racial and ethnic groups. People experiencing homelessness, people who inject drugs, and residents of long-term care facilities had substantially elevated GAS incidence rates. Among tested isolates, those nonsusceptible to macrolides and clindamycin increased from 12.7% in 2013 to 33.1% in 2022.

Conclusions  Invasive GAS infections increased substantially in 10 US states during a surveillance period from 2013 to 2022. Accelerated efforts to prevent and control GAS are needed, especially among groups at highest risk of infection.

DOI: 10.1001/jama.2025.0910

Source: https://jamanetwork.com/journals/jama/fullarticle/2832277