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Adamkova V, Adamkova VG, Kroneislova G, Zavora J, Kroneislova M, Huptych M, Lahoda Brodska H. Increasing Rate of Fatal Streptococcus pyogenes Bacteriemia-A Challenge for Prompt Diagnosis and Appropriate Therapy in Real Praxis. Microorganisms 2024; 12:995. [PMID: 38792824 PMCID: PMC11124258 DOI: 10.3390/microorganisms12050995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Streptococcus pyogenes, group A streptococci (GAS) bacteriaemia, is a life-threatening infection with high mortality, requiring fast diagnosis together with the use of appropriate antibiotic therapy as soon as possible. Our study analysed data from 93 patients with GAS bacteraemia at the General University Hospital in Prague between January 2006 and March 2024. In the years 2016-2019 there was an increase in GAS bacteraemia. Mortality in the period 2006-2019 was 21.9%; in the period 2020-2024, the mortality increased to 41.4%, p = 0.08. At the same time, in the post-2020 period, the time from hospital admission to death was reduced from 9.5 days to 3 days. A significant predictor of worse outcome in this period was high levels of procalcitonin, >35.1 µg/L (100% sensitivity and 82.35% specificity), and lactate, >5 mmol/L (90.91% sensitivity and 91.67% specificity). Myoglobin was a significant predictor in both compared periods, the AUC was 0.771, p = 0.044, and the AUC was an even 0.889, p ≤ 0.001, respectively. All isolates of S. pyogenes were susceptible to penicillin, and resistance to clindamycin was 20.3% from 2006-2019 and 10.3% in 2020-2024. Appropriate therapy was initiated in 89.1%. and 96.6%, respectively. We hypothesise that the increase in mortality after 2020 might be due to a decrease in the immune status of the population.
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Affiliation(s)
- Vaclava Adamkova
- Clinical Microbiology and ATB Centre, General University Hospital, 128 08 Prague, Czech Republic
| | | | - Gabriela Kroneislova
- Clinical Microbiology and ATB Centre, General University Hospital, 128 08 Prague, Czech Republic
| | - Jan Zavora
- Clinical Microbiology and ATB Centre, General University Hospital, 128 08 Prague, Czech Republic
- Department of Medical Microbiology, Palacky University, 779 00 Olomouc, Czech Republic
| | - Marie Kroneislova
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Surgery, University Hospital Bulovka, 180 00 Prague, Czech Republic
| | - Michal Huptych
- Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, 160 00 Prague, Czech Republic
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Gatica S, Fuentes B, Rivera-Asín E, Ramírez-Céspedes P, Sepúlveda-Alfaro J, Catalán EA, Bueno SM, Kalergis AM, Simon F, Riedel CA, Melo-Gonzalez F. Novel evidence on sepsis-inducing pathogens: from laboratory to bedside. Front Microbiol 2023; 14:1198200. [PMID: 37426029 PMCID: PMC10327444 DOI: 10.3389/fmicb.2023.1198200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Sepsis is a life-threatening condition and a significant cause of preventable morbidity and mortality globally. Among the leading causative agents of sepsis are bacterial pathogens Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pyogenes, along with fungal pathogens of the Candida species. Here, we focus on evidence from human studies but also include in vitro and in vivo cellular and molecular evidence, exploring how bacterial and fungal pathogens are associated with bloodstream infection and sepsis. This review presents a narrative update on pathogen epidemiology, virulence factors, host factors of susceptibility, mechanisms of immunomodulation, current therapies, antibiotic resistance, and opportunities for diagnosis, prognosis, and therapeutics, through the perspective of bloodstream infection and sepsis. A list of curated novel host and pathogen factors, diagnostic and prognostic markers, and potential therapeutical targets to tackle sepsis from the research laboratory is presented. Further, we discuss the complex nature of sepsis depending on the sepsis-inducing pathogen and host susceptibility, the more common strains associated with severe pathology and how these aspects may impact in the management of the clinical presentation of sepsis.
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Affiliation(s)
- Sebastian Gatica
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Brandon Fuentes
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Elizabeth Rivera-Asín
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Paula Ramírez-Céspedes
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Javiera Sepúlveda-Alfaro
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo A. Catalán
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Simon
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Claudia A. Riedel
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Felipe Melo-Gonzalez
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
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Mu X, Wang Y, Sun L, Zhao S, Jin X, Zhang J, Yu Y, Wu X. Invasive Infection With emm3/ST15 Streptococcus pyogenes: The First Case Report From China and Complete Genome Analysis. Front Med (Lausanne) 2022; 9:861087. [PMID: 35615092 PMCID: PMC9126071 DOI: 10.3389/fmed.2022.861087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Streptococcus pyogenes (GAS) may cause severe invasive disease with a high fatality rate, especially M3-type strains, which are less common in China. Here, we report the first emm3/ST15 invasive GAS infection case in China. The patient was diagnosed with severe skin and soft tissue infection (SSTI) and septicaemia caused by one GAS strain. Antibiotic susceptibility tests showed that the isolate was susceptible to all tested drugs. Antimicrobial therapy was then applied, and the patient fully recovered and was discharged from the hospital on Day 43. Whole-genome sequencing was carried out using the Illumina and Oxford Nanopore platforms and revealed this to be the first emm3/ST15-type GAS invasive infection in China. The closely related emm3/ST15-type GAS strains are MGAS315 from the United States and M3-b from Japan. Our finding is a warning that we should pay attention to invasive M3-type GAS infections in China and indicates the global spread of the highly virulent emm3/ST15 GAS strain.
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Affiliation(s)
- Xinli Mu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Regional Medical Center for National Institute of Respiratory Diseases, Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Yanfei Wang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Regional Medical Center for National Institute of Respiratory Diseases, Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Lu Sun
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Regional Medical Center for National Institute of Respiratory Diseases, Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Shanshan Zhao
- Department of Clinical Laboratory, Shangyu People's Hospital, Shaoxing, China
| | - Xi Jin
- Centre of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Junli Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Regional Medical Center for National Institute of Respiratory Diseases, Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Regional Medical Center for National Institute of Respiratory Diseases, Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Xueqing Wu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Regional Medical Center for National Institute of Respiratory Diseases, Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
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Aguilera-Alonso D, Kirchschläger Nieto S, Ara Montojo MF, Sanz Santaeufemia FJ, Saavedra-Lozano J, Soto B, Caminoa MB, Berzosa A, Prieto Tato L, Cercenado E, Tagarro A, Molina Arana D, Alonso Sanz M, Romero Gómez MP, Chaves Sánchez F, Baquero-Artigao F. Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes. Pediatr Infect Dis J 2022; 41:e235-e242. [PMID: 35333816 DOI: 10.1097/inf.0000000000003503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.
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Affiliation(s)
- David Aguilera-Alonso
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Jesús Saavedra-Lozano
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Department of Pediatrics, Hospital de Getafe, Madrid, Spain
| | | | - Arantxa Berzosa
- Department of Pediatrics, Hospital Clinico San Carlos, Madrid, Spain
| | - Luis Prieto Tato
- Department of Pediatric Infectious Diseases, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Emilia Cercenado
- Department of Microbiology, Hospital General Universitario Gregorio Marañón, CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Alfredo Tagarro
- Department of Pediatrics, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - María Pilar Romero Gómez
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
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Amari K, Tago M, Katsuki NE, Yamashita SI. Diverse disease processes of group A Streptococcus infection including severe invasive infections among members of a family. BMJ Case Rep 2021; 14:14/4/e241339. [PMID: 33858899 PMCID: PMC8054054 DOI: 10.1136/bcr-2020-241339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We herein report three cases of group A Streptococcus (GAS) infection in a family. Patient 1, a 50-year-old woman, was transferred to our hospital in shock with acute respiratory distress syndrome, swelling in the right neck and erythemata on both lower extremities. She required intubation because of laryngeal oedema. At the same time, patient 2, a 48-year-old man, was admitted because of septic shock, pneumonia and a pulmonary abscess. Five days later, patient 3, a 91-year-old woman, visited our clinic with bloody stool. All three patients were cured by antibiotics, and GAS was detected by specimen cultures. During these patients' clinical course, an 84-year-old woman was found dead at home after having been diagnosed with type A influenza. All four patients lived in the same apartment. The GAS genotypes detected in the first three patients were identical. When treating patients with GAS, appropriate management of close contacts is mandatory.
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Affiliation(s)
- Kaori Amari
- Department of General Medicine, Saga University Hospital, Saga, Japan.,Department of Emergency Medicine, Saga-Ken Medical Centre, Koseikan, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
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Complete Genome Sequences of Three Invasive Strains of Streptococcus pyogenes Subtype emm5.23 Isolated in Scotland. Microbiol Resour Announc 2021; 10:10/15/e00101-21. [PMID: 33858921 PMCID: PMC8050963 DOI: 10.1128/mra.00101-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pyogenesemm5.23 is uncommon; however, it has recently been involved in a relatively high proportion of cases of invasive disease in Scotland. Here, we report the complete genome sequences of three emm5.23 isolates, which may be used as a reference to investigate the virulence and epidemiology of this strain. Streptococcus pyogenesemm5.23 is uncommon; however, it has recently been involved in a relatively high proportion of cases of invasive disease in Scotland. Here, we report the complete genome sequences of three emm5.23 isolates, which may be used as a reference for investigating the virulence and epidemiology of this strain.
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