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Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis
OBJECTIVES: To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS). DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies. ELIG...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716873/ https://www.ncbi.nlm.nih.gov/pubmed/36456018 http://dx.doi.org/10.1136/bmjopen-2022-063023 |
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author | Bartoszko, Jessica J Elias, Zeyad Rudziak, Paulina Lo, Carson K L Thabane, Lehana Mertz, Dominik Loeb, Mark |
author_facet | Bartoszko, Jessica J Elias, Zeyad Rudziak, Paulina Lo, Carson K L Thabane, Lehana Mertz, Dominik Loeb, Mark |
author_sort | Bartoszko, Jessica J |
collection | PubMed |
description | OBJECTIVES: To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS). DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies. ELIGIBILITY CRITERIA: Pairs of reviewers independently screened potentially eligible studies of patients with Group A Streptococcus-induced STSS that quantified the association between at least one prognostic factor and outcome of interest. DATA EXTRACTION AND SYNTHESIS: We performed random-effects meta-analysis after duplicate data extraction and risk of bias assessments. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: One randomised trial and 40 observational studies were eligible (n=1918 patients). We found a statistically significant association between clindamycin treatment and mortality (n=144; OR 0.14, 95% CI 0.06 to 0.37), but the certainty of evidence was low. Within clindamycin-treated STSS patients, we found a statistically significant association between intravenous Ig treatment and mortality (n=188; OR 0.34, 95% CI 0.15 to 0.75), but the certainty of evidence was also low. The odds of mortality may increase in patients ≥65 years when compared with patients 18–64 years (n=396; OR 2.37, 95% CI 1.47 to 3.84), but the certainty of evidence was low. We are uncertain whether non-steroidal anti-inflammatory drugs increase the odds of mortality (n=50; OR 4.14, 95% CI 1.13 to 15.14; very low certainty). Results failed to show a significant association between any other prognostic factor and outcome combination (very low to low certainty evidence) and no studies quantified the association between a prognostic factor and morbidity post-infection in STSS survivors. CONCLUSIONS: Treatment with clindamycin and within clindamycin-treated patients, IVIG, was each significantly associated with mortality, but the certainty of evidence was low. Future research should focus on morbidity post-infection in STSS survivors. PROSPERO REGISTRATION NUMBER: CRD42020166961. |
format | Online Article Text |
id | pubmed-9716873 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-97168732022-12-03 Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis Bartoszko, Jessica J Elias, Zeyad Rudziak, Paulina Lo, Carson K L Thabane, Lehana Mertz, Dominik Loeb, Mark BMJ Open Infectious Diseases OBJECTIVES: To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS). DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies. ELIGIBILITY CRITERIA: Pairs of reviewers independently screened potentially eligible studies of patients with Group A Streptococcus-induced STSS that quantified the association between at least one prognostic factor and outcome of interest. DATA EXTRACTION AND SYNTHESIS: We performed random-effects meta-analysis after duplicate data extraction and risk of bias assessments. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: One randomised trial and 40 observational studies were eligible (n=1918 patients). We found a statistically significant association between clindamycin treatment and mortality (n=144; OR 0.14, 95% CI 0.06 to 0.37), but the certainty of evidence was low. Within clindamycin-treated STSS patients, we found a statistically significant association between intravenous Ig treatment and mortality (n=188; OR 0.34, 95% CI 0.15 to 0.75), but the certainty of evidence was also low. The odds of mortality may increase in patients ≥65 years when compared with patients 18–64 years (n=396; OR 2.37, 95% CI 1.47 to 3.84), but the certainty of evidence was low. We are uncertain whether non-steroidal anti-inflammatory drugs increase the odds of mortality (n=50; OR 4.14, 95% CI 1.13 to 15.14; very low certainty). Results failed to show a significant association between any other prognostic factor and outcome combination (very low to low certainty evidence) and no studies quantified the association between a prognostic factor and morbidity post-infection in STSS survivors. CONCLUSIONS: Treatment with clindamycin and within clindamycin-treated patients, IVIG, was each significantly associated with mortality, but the certainty of evidence was low. Future research should focus on morbidity post-infection in STSS survivors. PROSPERO REGISTRATION NUMBER: CRD42020166961. BMJ Publishing Group 2022-12-01 /pmc/articles/PMC9716873/ /pubmed/36456018 http://dx.doi.org/10.1136/bmjopen-2022-063023 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Infectious Diseases Bartoszko, Jessica J Elias, Zeyad Rudziak, Paulina Lo, Carson K L Thabane, Lehana Mertz, Dominik Loeb, Mark Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
title | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
title_full | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
title_fullStr | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
title_full_unstemmed | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
title_short | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
title_sort | prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
topic | Infectious Diseases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716873/ https://www.ncbi.nlm.nih.gov/pubmed/36456018 http://dx.doi.org/10.1136/bmjopen-2022-063023 |
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