อาการทางคลินิกและผลความไวต่อยาปฏิชีวนะของเชื้อ Group A Streptococcus ในเด็กที่มาด้วยไข้และเจ็บคอในโรงพยาบาลตติยภูมิ
อาการทางคลินิกและผลความไวของเชื้อ Group A Streptococcus
คำสำคัญ:
สเตรปโตคอคคัสกรุ๊ปเอ, คออักเสบ, เพาะเชื้อในคอบทคัดย่อ
อาการเจ็บคอในเด็กมักเกิดจากไวรัส ส่วนแบคทีเรียที่พบบ่อยเกิดจากเชื้อสเตรปโตคอคคัสกรุ๊ปเอ การศึกษาแบบไปข้างหน้านี้มีวัตถุประสงค์เพื่อประเมินอาการทางคลินิกของคออักเสบจากเชื้อสเตรปโตคอคคัสกรุ๊ปเอและผลความไวของเชื้อต่อยาปฏิชีวนะใน เด็ก ศึกษาระหว่าง 1 พฤษภาคม พ.ศ. 2559 ถึง 30 เมษายน พ.ศ. 2560 ในเด็กอายุ 1-15 ปีที่เข้ารับการรักษาด้วยอาการไข้และเจ็บคอภายใน 7 วันที่แผนกผู้ป่วยเด็กของโรงพยาบาลมหาวิทยาลัยนเรศวร มีผู้ป่วย 134 คน ผลการเพาะเชื้อในคอพบเชื้อสเตรปโตคอคคัสกรุ๊ปเอ 10 คน (ร้อยละ 7.5) และไม่พบสเตรปโตคอคคัสกรุ๊ปเอ 124 คน (ร้อยละ 92.5) ได้รับการวินิจฉัยเป็นโรคคออักเสบร้อย ละ 42.6 โดยกลุ่มที่ผลเพาะเชื้อพบสเตรปโตคอคคัสกรุ๊ปเอนั้นตรวจร่างกายพบต่อมทอนซิลอักเสบเป็นหนอง จุดเลือดออกที่เพดานอ่อน และผื่น โดยพบผื่น scarlatiniform rash ในกลุ่มที่พบเชื้อสเตรปโตคอคคัสกรุ๊ปเอมากกว่าอย่างมีนัยสำคัญทางสถิติ เชื้อไวต่อยาเพนนิซิลินทั้งหมดและดื้อยากลุ่มแมคโคไรด์ร้อยละ 10 นั่นคือเด็กที่มีอาการไข้และเจ็บคอภายใน 7 วันร่วมกับอาการ ผื่น scarlatiniform rash ที่มีสาเหตุจากการติดเชื้อสเตรปโตคอคคัสกรุ๊ปเอรักษาได้ผลดีด้วยยากลุ่มเพนนิซิลิน
References
1. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Inf Dis 2012;55(10):e86-102.
2. Lindbaek M, Hoiby EA, Lermark G, Steinsholt IM, Hjortdahl P. Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A. Br J Gen Pract 2005;55(517):615-9.
3. American Academy of Pediatrics. Group A streptococcal infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Red Book 2018-2021: Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village: American Academy of
Pediatrics; 2018. p.748-62.
4. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005;5(11):685-94.
5. Wessels MR. Streptococcal pharyngitis. N Engl J Med 2011;364(7):648-55.
6. Greer R, Althaus T, Ling C, Intralawan D, Nedsuwan S, Thaipadungpanit J, et al. Prevalence of group A streptococcus in primary care patients and the utility of C-reactive protein and clinical scores for its identification in Thailand. Am J Trop Med Hyg 2020;102(2):377-83.
7. Aalbers J, O'Brien KK, Chan WS, Falk GA, Teljeur C, Dimitrov BD, et al. Predicting streptococcal pharyngitis in adults in primary care: A systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011;9(67):1-11.
8. Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013;132(6):1146-54.
9. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med 2012;172 (11):847-52.
10. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158(1):75-83.
11. The Thai Society of Pediatric Respiratory and Critical Care Medicine, The Royal Collage Pediatricians of Thailand. Guidelines for the treatment of acute respiratory tract infections in children 2019. Bangkok: Beyond Enterprise Co., Ltd; 2019. p.19-26.
12. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009;79(5):383-90.
13. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004;7(3):571-80.
14. Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatric adverse drug events in the outpatient setting: An 11-year national analysis. Pediatrics 2009;124(4):e744-50.
15. Cohen AL, Budnitz DS, Weidenbach KN, Jernigan DB, Schroeder TJ, Shehab N, et al. National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents. J Pediatr 2008;152(3):416-21.
16. Gagliotti C, Nobilio L, Milandri M, Moro ML, Romagna E. Antibiotic Resistance Study Group, macrolide prescriptions and erythromycin resistance of Streptococcus pyogenes. Clin Infect Dis 2006;42(8):1153-56.
17. Treebupachatsakul P, Tiengrim S, Thamlikitkul V. Upper respiratory tract infection in Thai adults: Prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines. J Med Assoc Thai 2006:89(8);1178-86.
18. Boonyasiri A, Thamlikitkul V. Effectiveness of multifaceted interventions on rational use of antibiotics for patients with upper respiratory tract infections and acute diarrhea. J Med Assoc Thai 2014;97 (Suppl 3):S13-9.
19. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal disease. Lancet Infect Dis 2005;5(11):685-94.
20. Cohen JF, Cohen R, Bidet P, Elbez A, Levy C, Bossuyt PM, et al. Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective, multicenter study. PLoS One 2017;12(2):e0172871.
21. Limbergen JV, Kalima P, Taheri S, Beattie TF. Streptococcus A in paediatric accident and emergency: Are rapid streptococcal tests and clinical examination of any help?. Emerg Med J 2006;23(1):32-4.
22. Nishiyama M, Morioka I, Taniguchi-Ikeda M, Mori T, Tomioka K, Nakanishi K, et al. Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre. J Int Med Res 2018;46(5):1791-800.
23. Lin MH, Chang PF, Fong WK, Yen CW, Hung KL, Lin SJ. Epidemiological and clinical features of group A streptococcus pharyngitis in children. Acta Paediatr Taiwan 2003;44(5):274-8.
24. Roggen I, van Berlaer G, Gordts F, Pierard D, Hubloue I. Centor criteria in children in a Paediatric Emergency Department:For what it is worth. BMJ Open 2013;3(4):e002712.
25. Little P. Penicillin for acute sore throat in children: Randomised, double blind trial. Commentary: More valid criteria may be needed. BMJ 2003;327(7427):1327-8.
26. Tanz RR, Shulman ST, Shortridge VD, Kabat W, Kabat K, Cederlund E, et al. Community- based surveillance in the United States of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis 2004;39(12):1794-801.
27. Bingen E, Bidet P, Mihaila-Amrouche L, Doit C, Forcet S, Brahimi N, et al. Emergence of macrolide-resistant Streptococcus pyogenes strains in French children. Antimicrob Agents Chemother 2004;48(9):3559-62.
28. Gherardi G, Petrelli D, Di Luca MC, Pimentel de Araujo F, Bernaschi P, Repetto A, et al. Decline in macrolide resistance rates among Streptococcus pyogenes causing pharyngitis in children isolated in Italy. Eur J Clin Microbiol Infect Dis 2015;34(9):1797-802.
29. Tack KJ, Hedrick JA, Rothstein E, Nemeth MA, Keyserling C, Pichichero ME. A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med 1997;151(1):45-9.
2. Lindbaek M, Hoiby EA, Lermark G, Steinsholt IM, Hjortdahl P. Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A. Br J Gen Pract 2005;55(517):615-9.
3. American Academy of Pediatrics. Group A streptococcal infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Red Book 2018-2021: Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village: American Academy of
Pediatrics; 2018. p.748-62.
4. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005;5(11):685-94.
5. Wessels MR. Streptococcal pharyngitis. N Engl J Med 2011;364(7):648-55.
6. Greer R, Althaus T, Ling C, Intralawan D, Nedsuwan S, Thaipadungpanit J, et al. Prevalence of group A streptococcus in primary care patients and the utility of C-reactive protein and clinical scores for its identification in Thailand. Am J Trop Med Hyg 2020;102(2):377-83.
7. Aalbers J, O'Brien KK, Chan WS, Falk GA, Teljeur C, Dimitrov BD, et al. Predicting streptococcal pharyngitis in adults in primary care: A systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011;9(67):1-11.
8. Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013;132(6):1146-54.
9. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med 2012;172 (11):847-52.
10. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158(1):75-83.
11. The Thai Society of Pediatric Respiratory and Critical Care Medicine, The Royal Collage Pediatricians of Thailand. Guidelines for the treatment of acute respiratory tract infections in children 2019. Bangkok: Beyond Enterprise Co., Ltd; 2019. p.19-26.
12. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009;79(5):383-90.
13. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004;7(3):571-80.
14. Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatric adverse drug events in the outpatient setting: An 11-year national analysis. Pediatrics 2009;124(4):e744-50.
15. Cohen AL, Budnitz DS, Weidenbach KN, Jernigan DB, Schroeder TJ, Shehab N, et al. National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents. J Pediatr 2008;152(3):416-21.
16. Gagliotti C, Nobilio L, Milandri M, Moro ML, Romagna E. Antibiotic Resistance Study Group, macrolide prescriptions and erythromycin resistance of Streptococcus pyogenes. Clin Infect Dis 2006;42(8):1153-56.
17. Treebupachatsakul P, Tiengrim S, Thamlikitkul V. Upper respiratory tract infection in Thai adults: Prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines. J Med Assoc Thai 2006:89(8);1178-86.
18. Boonyasiri A, Thamlikitkul V. Effectiveness of multifaceted interventions on rational use of antibiotics for patients with upper respiratory tract infections and acute diarrhea. J Med Assoc Thai 2014;97 (Suppl 3):S13-9.
19. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal disease. Lancet Infect Dis 2005;5(11):685-94.
20. Cohen JF, Cohen R, Bidet P, Elbez A, Levy C, Bossuyt PM, et al. Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective, multicenter study. PLoS One 2017;12(2):e0172871.
21. Limbergen JV, Kalima P, Taheri S, Beattie TF. Streptococcus A in paediatric accident and emergency: Are rapid streptococcal tests and clinical examination of any help?. Emerg Med J 2006;23(1):32-4.
22. Nishiyama M, Morioka I, Taniguchi-Ikeda M, Mori T, Tomioka K, Nakanishi K, et al. Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre. J Int Med Res 2018;46(5):1791-800.
23. Lin MH, Chang PF, Fong WK, Yen CW, Hung KL, Lin SJ. Epidemiological and clinical features of group A streptococcus pharyngitis in children. Acta Paediatr Taiwan 2003;44(5):274-8.
24. Roggen I, van Berlaer G, Gordts F, Pierard D, Hubloue I. Centor criteria in children in a Paediatric Emergency Department:For what it is worth. BMJ Open 2013;3(4):e002712.
25. Little P. Penicillin for acute sore throat in children: Randomised, double blind trial. Commentary: More valid criteria may be needed. BMJ 2003;327(7427):1327-8.
26. Tanz RR, Shulman ST, Shortridge VD, Kabat W, Kabat K, Cederlund E, et al. Community- based surveillance in the United States of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis 2004;39(12):1794-801.
27. Bingen E, Bidet P, Mihaila-Amrouche L, Doit C, Forcet S, Brahimi N, et al. Emergence of macrolide-resistant Streptococcus pyogenes strains in French children. Antimicrob Agents Chemother 2004;48(9):3559-62.
28. Gherardi G, Petrelli D, Di Luca MC, Pimentel de Araujo F, Bernaschi P, Repetto A, et al. Decline in macrolide resistance rates among Streptococcus pyogenes causing pharyngitis in children isolated in Italy. Eur J Clin Microbiol Infect Dis 2015;34(9):1797-802.
29. Tack KJ, Hedrick JA, Rothstein E, Nemeth MA, Keyserling C, Pichichero ME. A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med 1997;151(1):45-9.
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2020-10-13
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