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Meta-Analysis
. 2022 Dec 1;12(12):e063023.
doi: 10.1136/bmjopen-2022-063023.

Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis

Jessica J Bartoszko  1 , Zeyad Elias  2 , Paulina Rudziak  3 , Carson K L Lo  4 , Lehana Thabane  1   5 , Dominik Mertz  1   4 , Mark Loeb  6   7
Affiliations
Meta-Analysis

Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis

Jessica J Bartoszko et al. BMJ Open. .

Abstract

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.

Keywords: bacteriology; epidemiology; general medicine (see internal medicine).

PubMed Disclaimer

Conflict of interest statement

Competing interests: ML declares grants or contracts from the WHO, consulting fees from AVIR Pharma, and participating on data safety monitoring or advisory boards for Paladin Labs and Sunovion Pharmaceuticals.

Figures

Figure 1
Figure 1
PRISMA study flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Meta-analyses comparing IVIG treatment to no IVIG treatment for the outcome mortality in (A) all STSS patients; and (B) the subset of STSS patients treated with clindamycin. Please note proportions are blank for study rows where we meta-analysed adjusted ORs instead of crude proportions. IVIG, intravenous Ig; STSS, streptococcal toxic shock syndrome.
See this image and copyright information in PMC

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