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Bertram R, Itzek A, Marr L, Manzke J, Voigt S, Chapot V, van der Linden M, Rath PM, Hitzl W, Steinmann J. Divergent effects of emm types 1 and 12 on invasive group A streptococcal infections-results of a retrospective cohort study, Germany 2023. J Clin Microbiol 2024:e0063724. [PMID: 38990040 DOI: 10.1128/jcm.00637-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024] Open
Abstract
As a potential side effect of the severe acute respiratory syndrome coronavirus type 2 pandemic, invasive group A Streptococcus (iGAS) infections in Europe have increased dramatically in both children and adults in the end of 2022. This epidemiological and molecular study describes the distributions of streptococcal genes encoding the M antigen (emm types) and superantigens in patients with invasive and non-invasive GAS infections. From December 2022 to December 2023, a total of 163 GAS isolates were collected from sterile and non-sterile sites of patients at five hospitals in Germany including two tertiary care centers. Genes encoding M protein and superantigens were determined following the guidelines of CDC Streptococcus laboratory. Patients' characteristics were reviewed retrospectively. Correlations of clinical factors, emm types, and superantigens with rates of invasive infections were analyzed. Of the 163 included GAS cases, 112 (69%) were considered as invasive. In total, 33 different emm types were observed, of which emm1.0 (n = 49; 30%), emm89.0 (n = 15; 9%), and emm12.0 (n = 14; 9%) were most prevalent. In total, 70% of emm1.0 isolates belonged to M1UK lineage. No difference in invasive infections was observed for the M1UK lineage compared with other emm1.0 isolates. However, the emm1.0 type, presence of speA1-3, speG, or speJ, as well as adulthood were significantly associated with invasive infections. In contrast, emm12.0 isolates were significantly less associated with invasive infections. Multivariable analysis confirmed a significant influence of speJ and adulthood on iGAS infections. This study underlines the importance of continuous monitoring of genomic trends and identification of emerging GAS variants. This may aid in delineating pathogenicity factors of Streptococcus pyogenes that propel invasive infections.
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Affiliation(s)
- Ralph Bertram
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Andreas Itzek
- Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Lisa Marr
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Jana Manzke
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Sebastian Voigt
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Valérie Chapot
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark van der Linden
- Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang Hitzl
- Department of Research and Innovation Management, Biostatistics and publication of clinical trial studies, Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Joerg Steinmann
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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2
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Sabbatucci M, Ashiru-Oredope D, Barbier L, Bohin E, Bou-Antoun S, Brown C, Clarici A, Fuentes C, Goto T, Maraglino F, Morin J, Rönnefahrt I, Sanwidi A, Triggs-Hodge C, Vitiello A, Zovi A, Gelormini M, Lo Fo Wong D. Tracking progress on antimicrobial resistance by the quadripartite country self-assessment survey (TrACSS) in G7 countries, 2017-2023: opportunities and gaps. Pharmacol Res 2024; 204:107188. [PMID: 38705262 PMCID: PMC11156590 DOI: 10.1016/j.phrs.2024.107188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
Antimicrobial resistance (AMR) poses serious challenges to the healthcare systems worldwide. Multiple factors and activities contribute to the development and spread of antimicrobial-resistant microorganisms. Monitoring progress in combating AMR is fundamental at both global and national levels to drive multisectoral actions, identify priorities, and coordinate strategies. Since 2017, the World Health Organization (WHO) has collected data through the Tracking AMR Country Self-Assessment Survey (TrACSS). TrACSS data are published in a publicly-available database. In 2023, 71 (59.9%) out of 177 responding countries reported the existence of a monitoring and evaluation plan for their National Action Plan (NAP) on AMR, and just 20 countries (11.3%) the allocation of funding to support NAP implementation. Countries reported challenges including limited financial and human resources, lack of technical capacity, and variable political commitment. Even across the Group of Seven (G7) countries, which represent some of the world's most advanced economies, many areas still need improvement, such as full implementation of infection prevention and control measures, adoption of WHO access/watch/reserve (AWaRe) classification of antibiotics, effective integration of laboratories in AMR surveillance in the animal health and food safety sectors, training and education, good manufacturing and hygiene practices in food processing, optimising pesticides use and environmental residues of antimicrobial drugs. Continuous and coordinated efforts are needed to strengthen multisectoral engagement to fight AMR.
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Affiliation(s)
- Michela Sabbatucci
- Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, Ministry of Health, Rome 00144, Italy.
| | - Diane Ashiru-Oredope
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London NW9 5EQ, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.
| | - Laura Barbier
- French Ministry of Ecological Transition and Territorial Cohesion, La Défense 92055, France.
| | - Elisa Bohin
- French Ministry of Agriculture and Food Sovereignty, Paris 75015, France.
| | - Sabine Bou-Antoun
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London NW9 5EQ, United Kingdom.
| | - Colin Brown
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London NW9 5EQ, United Kingdom; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.
| | - Alexandra Clarici
- Federal Ministry of Health, Division "One Health, Antimicrobial Resistance", Berlin 10117, Germany.
| | - Claire Fuentes
- French Ministry of Agriculture and Food Sovereignty, Paris 75015, France.
| | - Takahiro Goto
- International Affairs Division, Minister's Secretariat, Ministry of Health, Labour and Welfare, Tokyo 100-8916, Japan.
| | - Francesco Maraglino
- Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, Ministry of Health, Rome 00144, Italy.
| | - Julien Morin
- French Ministry of Health and Prevention, Paris 75007, France.
| | - Ines Rönnefahrt
- Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection, Division "Plant Protection Products, Biocides, Medicinal Products", Berlin 10117, Germany.
| | - Andrea Sanwidi
- Federal Ministry of Food and Agriculture, Division "Veterinary medicines, residues of pharmacologically active substances in food", Bonn 53123, Germany.
| | - Carry Triggs-Hodge
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London NW9 5EQ, United Kingdom.
| | - Antonio Vitiello
- Directorate General Health Prevention, Communicable Diseases and International Prophylaxis, Ministry of Health, Rome 00144, Italy.
| | - Andrea Zovi
- Directorate General for Hygiene, Food Safety and Nutrition, Ministry of Health, Rome 00144, Italy.
| | - Marcello Gelormini
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
| | - Danilo Lo Fo Wong
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
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Vieira A, Wan Y, Ryan Y, Li HK, Guy RL, Papangeli M, Huse KK, Reeves LC, Soo VWC, Daniel R, Harley A, Broughton K, Dhami C, Ganner M, Ganner MA, Mumin Z, Razaei M, Rundberg E, Mammadov R, Mills EA, Sgro V, Mok KY, Didelot X, Croucher NJ, Jauneikaite E, Lamagni T, Brown CS, Coelho J, Sriskandan S. Rapid expansion and international spread of M1 UK in the post-pandemic UK upsurge of Streptococcus pyogenes. Nat Commun 2024; 15:3916. [PMID: 38729927 PMCID: PMC11087535 DOI: 10.1038/s41467-024-47929-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
The UK observed a marked increase in scarlet fever and invasive group A streptococcal infection in 2022 with severe outcomes in children and similar trends worldwide. Here we report lineage M1UK to be the dominant source of invasive infections in this upsurge. Compared with ancestral M1global strains, invasive M1UK strains exhibit reduced genomic diversity and fewer mutations in two-component regulator genes covRS. The emergence of M1UK is dated to 2008. Following a bottleneck coinciding with the COVID-19 pandemic, three emergent M1UK clades underwent rapid nationwide expansion, despite lack of detection in previous years. All M1UK isolates thus-far sequenced globally have a phylogenetic origin in the UK, with dispersal of the new clades in Europe. While waning immunity may promote streptococcal epidemics, the genetic features of M1UK point to a fitness advantage in pathogenicity, and a striking ability to persist through population bottlenecks.
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Affiliation(s)
- Ana Vieira
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
| | - Yu Wan
- Department of Infectious Disease, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Yan Ryan
- Reference Services Division, UK Health Security Agency, London, UK
| | - Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Rebecca L Guy
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Maria Papangeli
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Kristin K Huse
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Lucy C Reeves
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Valerie W C Soo
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Roger Daniel
- Reference Services Division, UK Health Security Agency, London, UK
| | | | - Karen Broughton
- Reference Services Division, UK Health Security Agency, London, UK
| | - Chenchal Dhami
- Reference Services Division, UK Health Security Agency, London, UK
| | - Mark Ganner
- Reference Services Division, UK Health Security Agency, London, UK
| | | | - Zaynab Mumin
- Reference Services Division, UK Health Security Agency, London, UK
| | - Maryam Razaei
- Reference Services Division, UK Health Security Agency, London, UK
| | - Emma Rundberg
- Reference Services Division, UK Health Security Agency, London, UK
| | - Rufat Mammadov
- Reference Services Division, UK Health Security Agency, London, UK
| | - Ewurabena A Mills
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Vincenzo Sgro
- Department of Infectious Disease, Imperial College London, London, UK
| | - Kai Yi Mok
- Department of Infectious Disease, Imperial College London, London, UK
| | - Xavier Didelot
- School of Life Sciences and Department of Statistics, University of Warwick, Coventry, UK
| | - Nicholas J Croucher
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Elita Jauneikaite
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Theresa Lamagni
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Colin S Brown
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Juliana Coelho
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK.
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK.
- Reference Services Division, UK Health Security Agency, London, UK.
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK.
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK.
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK.
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Wolters M, Berinson B, Degel-Brossmann N, Hoffmann A, Bluszis R, Aepfelbacher M, Rohde H, Christner M. Population of invasive group A streptococci isolates from a German tertiary care center is dominated by the hypertoxigenic virulent M1 UK genotype. Infection 2024; 52:667-671. [PMID: 38064158 PMCID: PMC10954911 DOI: 10.1007/s15010-023-02137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 03/21/2024]
Abstract
PURPOSE Hypertoxigenic Streptococcus pyogenes emm1 lineage M1UK has recently been associated with upsurges of invasive infections and scarlet fever in several countries, but whole-genome sequencing surveillance data of lineages circulating in Germany is lacking. In this study, we investigated recent iGAS isolates from our laboratory at a German tertiary care center for the presence of the M1UK lineage. METHODS Whole-genome sequencing was employed to characterize a collection of 47 consecutive non-copy isolates recovered from blood cultures (21) and tissue samples (26) in our laboratory between October 2022 and April 2023. RESULTS M protein gene (emm) typing distinguished 14 different emm types, with emm1 (17) being the dominant type. Single-nucleotide polymorphism (SNP) analysis confirmed the presence of all 27 SNPs characteristic for the M1UK lineage in 14 of 17 emm1 isolates. CONCLUSION This study has shown for the first time that M1UK is present in Germany and might constitute a driving force in the observed surge of GAS infections. This observation mirrors developments in the UK and other countries and underscores the importance of WGS surveillance to understand the epidemiology of GAS.
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Affiliation(s)
- Manuel Wolters
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Benjamin Berinson
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Nicole Degel-Brossmann
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Armin Hoffmann
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Rico Bluszis
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Martin Aepfelbacher
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Christner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
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5
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Chiang-Ni C, Hsu CY, Yeh YH, Chi CY, Wang S, Tsai PJ, Chiu CH. Detection of toxigenic M1 UK lineage group A Streptococcus clones in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:269-277. [PMID: 38278671 DOI: 10.1016/j.jmii.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND A new sublineage of emm1 group A Streptococcus (GAS), M1UK, has emerged in Europe, North America, and Australia. Notably, a significant portion of emm1 isolates in Asia, particularly in Hong Kong and mainland China, acquired scarlet fever-associated prophages following the 2011 Hong Kong scarlet fever outbreak. However, the presence of the M1UK sublineage has not yet been detected in Asia. METHODS This study included 181 GAS isolates (2011-2021). The emm type of these isolates were determined, and 21 emm1 isolates from blood or pleural fluid (2011-2021) and 10 emm1 isolates from throat swabs (2016-2018) underwent analysis. The presence of the scarlet fever-associated prophages and the specific single nucleotide polymorphisms of the M1UK clone were determined by polymerase chain reaction and the genome sequencing. RESULTS The M1UK lineage strains from throat swab and blood samples were identified. One of the M1UK strain in Taiwan carried the scarlet fever-associated prophage and therefore acquired the ssa, speC, and spd1 toxin repertoire. Nonetheless, the increase of M1UK was not observed until 2021, and there was a reduction in the diversity of emm types in 2020-2021, possibly due to the COVID-19 pandemic restriction policies in Taiwan. CONCLUSIONS Our results suggested that the M1UK lineage clone has introduced in Taiwan. In Taiwan, the COVID-19 restrictions were officially released in March 2023; therefore, it would be crucial to continuously monitor the M1UK expansion and its related diseases in the post COVID-19 era.
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Affiliation(s)
- Chuan Chiang-Ni
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Chih-Yun Hsu
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsuan Yeh
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yu Chi
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan; Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shuying Wang
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Jane Tsai
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Hsun Chiu
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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6
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Peghin M, Graziano E, Grossi PA. Skin and soft tissue infections in solid organ transplants. Curr Opin Infect Dis 2024; 37:112-120. [PMID: 38050739 DOI: 10.1097/qco.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted immune response. The purpose of this review is to outline current literature and describe open issues on the management of SSTI in this special population. RECENT FINDINGS Clinical presentation in SOT recipients can manifest as isolated skin lesions after primary inoculation or be the sign of a disseminated infection. Tissue samples for microscopy and histopathology are crucial to making an accurate diagnosis given the nonspecific and heterogeneous appearance of skin lesions. Multidisciplinary teams are required for a comprehensive diagnosis and management. SUMMARY SSTI are frequent contributors to morbidity and mortality in SOT. Specific research focused on the clinical presentation, risk factors and management in this special population is needed.
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Affiliation(s)
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
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7
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Beres SB, Olsen RJ, Long SW, Langley R, Williams T, Erlendsdottir H, Smith A, Kristinsson KG, Musser JM. Increase in invasive Streptococcus pyogenes M1 infections with close evolutionary genetic relationship, Iceland and Scotland, 2022 to 2023. Euro Surveill 2024; 29:2400129. [PMID: 38551096 PMCID: PMC10979525 DOI: 10.2807/1560-7917.es.2024.29.13.2400129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 04/01/2024] Open
Abstract
Group A Streptococcus isolates of the recently described M1UK clade have emerged to cause human infections in several European countries and elsewhere. Full-genome sequence analysis of M1 isolates discovered a close genomic relationship between some isolates from Scotland and the majority of isolates from Iceland causing serious infections in 2022 and 2023. Phylogenetic analysis strongly suggests that an isolate from or related to Scotland was the precursor to an M1UK variant responsible for almost all recent M1 infections in Iceland.
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Affiliation(s)
- Stephen B Beres
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, United States
| | - Randall J Olsen
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, United States
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, United States
| | - S Wesley Long
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, United States
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, United States
| | - Ross Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, Scotland
| | - Thomas Williams
- Department of Child Life and Health, University of Edinburgh, Edinburgh, Scotland
| | - Helga Erlendsdottir
- Department of Clinical Microbiology, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Andrew Smith
- College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, Scotland
- Scottish Microbiology Reference Laboratory, New Lister Building, Glasgow, Scotland
| | - Karl G Kristinsson
- Department of Clinical Microbiology, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - James M Musser
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, United States
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, United States
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8
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Nygaard U, Hartling UB, Munkstrup C, Nielsen AB, Dungu KHS, Schmidt LS, Glenthøj J, Matthesen AT, Rytter MJH, Holm M. Invasive group A streptococcal infections in children and adolescents in Denmark during 2022-23 compared with 2016-17 to 2021-22: a nationwide, multicentre, population-based cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:112-121. [PMID: 38103567 DOI: 10.1016/s2352-4642(23)00295-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND A historic increase in paediatric invasive group A streptococcal (iGAS) infections was reported globally in 2022. iGAS infections can lead to severe manifestations (eg, pleural empyema, necrotising fasciitis, toxic shock syndrome, osteomyelitis, septic arthritis, and meningitis). We aimed to compare the incidence and severity of iGAS infections overall, for distinct clinical phenotypes, and for GAS emm variants in Denmark in 2022-23 with reference to the previous six seasons (ie, 2016-17, 2017-18, 2018-19, 2019-20, 2020-21, and 2021-22). METHODS In this nationwide, multicentre, population-based cohort study, we included all children and adolescents in Denmark aged 0-17 years with a positive culture of GAS or GAS confirmed through PCR-based methods from otherwise sterile sites in 2022-23 and the previous six seasons from 2016-17 to 2021-22. For all seven seasons, data were obtained from week 21 to week 20 of the next year. Patients at all 18 paediatric hospital departments in Denmark were identified through the Danish Microbiology Database, in which iGAS isolates from sterile sites are prospectively registered, including emm typing. We obtained electronic medical health records for each patient admitted with a diagnosis of iGAS. We calculated the incidence of iGAS per 1 000 000 inhabitants aged 0-17 years in each season from week 21 to week 20 of the next year and the risk ratios (RRs) for incidence of iGAS, distinct disease manifestations, and emm variants in 2022-23 versus the three pre-COVID-19 seasons in 2016-17, 2017-18, and 2018-19 using Fisher's exact test and Pearson's χ2 test. FINDINGS Among the Danish population of 1 152 000 children and adolescents aged 0-17 years, 174 with iGAS disease were included. 76 children and adolescents with iGAS during 2022-23 were identified; 31 (41%) of 76 were female and 45 (59%) were male. 98 children and adolescents with iGAS during 2016-17 to 2021-22 were identified; 41 (42%) of 98 were female and 57 (58%) were male. There was an increase in incidence of iGAS from mean 22·6 (95% CI 14·7-33·1) per 1 000 000 children and adolescents during 2016-17 to 2018-19 to 66·0 (52·0-82·6) per 1 000 000 during 2023-23 (RR 2·9, 95% CI 1·9-4·6; p<0·0001). During the COVID-19 pandemic in 2019-20, 2020-21, and 2021-22, the mean incidence of iGAS was 6·1 (95% CI 2·4-12·5) per 1 000 000 children and adolescents. In 2022-23, there was a 9·5-fold increase in emm-12 (95% CI 2·2-40·8; p=0·0002) and a 2·7-fold increase in emm-1 (1·3-5·5; p=0·0037). The most common clinical manifestations of iGAS in 2022-23 were soft-tissue infections, which increased by 4·5-fold (1·9-10·9; p=0·0003), and complicated pneumonia with parapneumonic effusion, which increased by 4·0-fold (1·4-11·4; p=0·0059), both compared with the three pre-COVID-19 seasons. Overall, there was no increased severity of iGAS in 2022-23 compared with the previous six seasons as measured by median duration of hospital stay (8 days, IQR 4-14 vs 9 days, 5-15; p=0·39), paediatric intensive care unit (PICU) admission (17 [22%] of 76 vs 17 [17%] of 98; p=0·53), duration of stay in PICU (4 days, IQR 2-10 vs 4 days, 2-11; p=0·84), or mortality (three [4%] of 76 vs three [3%] of 98; p=1·00). In 2022-23, there was a 3·6-fold (95% CI 1·8-7·3; p=0·0001) increase in children with a preceding upper respiratory tract infection and a 4·6-fold (1·5-14·1; p=0·0034) increase in children with a preceding varicella-zoster infection, both compared with the three pre-COVID-19 seasons. INTERPRETATION In Denmark, the incidence of paediatric iGAS increased in 2022-23 compared with the three pre-COVID-19 seasons of 2016-17, 2017-18, and 2018-19. However, the course of iGAS disease in children and adolescents in 2022-23 was not more severe than in previous seasons. The high morbidity across all seasons highlights iGAS as a major invasive bacterial infection in children and adolescents. FUNDING Innovation Fund Denmark.
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Affiliation(s)
- Ulrikka Nygaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ulla Birgitte Hartling
- Department of Paediatrics and Adolescent Medicine, Hans Christian Andersen Children's Hospital, Odense, Denmark
| | - Charlotte Munkstrup
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Allan Bybeck Nielsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kia Hee Schultz Dungu
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lisbeth Samsø Schmidt
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics and Adolescent Medicine, Herlev University Hospital, Herlev, Denmark
| | - Jonathan Glenthøj
- Department of Paediatrics and Adolescent Medicine, Hillerød University Hospital, Hillerød, Denmark
| | - Astrid Thaarup Matthesen
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Maren Johanne Heilskov Rytter
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics and Adolescent Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Mette Holm
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A, Orieux A, Prevel R, Dumery M, Lascarrou JB, Zucman N, Reizine F, Fillatre P, Detollenaere C, Darreau C, Antier N, Saint-Léger M, Schnell G, La Combe B, Guesdon C, Bruna F, Guillon A, Varillon C, Lesieur O, Grand H, Bertrand B, Siami S, Oudeville P, Besnard C, Persichini R, Bauduin P, Thyrault M, Evrard M, Schnell D, Auchabie J, Auvet A, Rigaud JP, Beuret P, Leclerc M, Berger A, Ben Hadj Salem O, Lorber J, Stoclin A, Guisset O, Bientz L, Khan P, Guillotin V, Lacherade JC, Boyer A. Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study). Crit Care 2024; 28:4. [PMID: 38167516 PMCID: PMC10759709 DOI: 10.1186/s13054-023-04774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Group A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients' characteristics, and determine ICU mortality associated factors. METHODS We performed a retrospective multicenter cohort study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center's microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate. RESULTS Two hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively (p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients (n = 222) had a median SOFA score of 8 (5-13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71-21.60), p = 0.005), STSS (OR = 5.75 (1.71-19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05-22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03-15.59), p = 0.044), and diabetes (OR = 3.92 (1.42-10.79), p = 0.008) were significantly associated with ICU mortality. CONCLUSION The incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.
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Affiliation(s)
- Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Margot Dumery
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | | | - Noémie Zucman
- Service de Réanimation Médico-Chirurgicale, CH Annecy Genevois, Epagny Metz-Tessy, France
| | - Florian Reizine
- Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
| | - Pierre Fillatre
- Service de Réanimation Polyvalente, CH de Saint Brieuc, Saint Brieuc, France
| | - Charles Detollenaere
- Service de Réanimation - Unité de Soins Continus, CH de Boulogne Sur Mer, Boulogne, France
| | - Cédric Darreau
- Service de Réanimation Médico-Chirurgicale, CH Le Mans, Le Mans, France
| | | | | | - Guillaume Schnell
- Service de Réanimation Médico-Chirurgicale, Groupe Hospitalier du Havre, Le Havre, France
| | - Béatrice La Combe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Charlotte Guesdon
- Service de Réanimation Polyvalente, Centre Hospitalier de Pau, Pau, France
| | - Franklin Bruna
- Service de Réanimation, CH Alpes Leman, Contamine Sur Arve, France
| | - Antoine Guillon
- Service de Médecine Intensive Réanimation, INSERM, Centre d'Étude des Pathologies Respiratoires (CEPR), UMR 1100, CHRU de Tours, Université de Tours, Tours, France
| | - Caroline Varillon
- Service de Médecine Intensive Réanimation, CH Dunkirk, Dunkirk, France
| | - Olivier Lesieur
- Service de Réanimation Médico-Chirurgical, CH La Rochelle, La Rochelle, France
| | - Hubert Grand
- Service de Réanimation Polyvalente, Hôpital Robert Boulin, Libourne, France
| | - Benjamin Bertrand
- Service de Réanimation Polyvalente, CH Intercommunal Toulon, La Seyne sur Mer (CHITS), Toulon, France
| | - Shidasp Siami
- Service de Réanimation Polyvalente, CH Sud Essonne, Étampes, France
| | - Pierre Oudeville
- Service de Réanimation Médicale, Groupe Hospitalier Régional Mulhouse Sud Alsace (GHRMSA), Mulhouse, France
| | - Céline Besnard
- Service de Médecine Intensive Réanimation, CH Régional de Orléans, Orléans, France
| | - Romain Persichini
- Service de Réanimation Et Soins Continus, CH de Saintonge, Saintes, France
| | - Pierrick Bauduin
- Service de Médecine Intensive Réanimation, CHU de Caen, Caen, France
| | - Martial Thyrault
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord Essonne - site Longjumeau, Longjumeau, France
| | - Mathieu Evrard
- Service Réanimation Polyvalente et Surveillance Continue, CH de Lens, Lens, France
| | - David Schnell
- Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France
| | - Johann Auchabie
- Service de Réanimation Polyvalente, CH de Cholet, Cholet, France
| | - Adrien Auvet
- Service de Réanimation Polyvalente, CH de Dax, Dax, France
| | | | - Pascal Beuret
- Service de Réanimation et Soins Continus, CH de Roanne, Roanne, France
| | - Maxime Leclerc
- Service de Réanimation et Soins Intensifs Polyvalents, CH Mémorial Saint-Lô, Saint-Lô, France
| | - Asaël Berger
- Service de Réanimation, CH de Haguenau, Haguenau, France
| | - Omar Ben Hadj Salem
- Service de Réanimation Médico-Chirurgicale, CHI Meulan - les Mureaux, Meulan en Yvelines, France
| | - Julien Lorber
- Service de Médecine Intensive Réanimation, CH de Saint Nazaire, Saint Nazaire, France
| | - Annabelle Stoclin
- Département Interdisciplinaire d'Organisation des Parcours Patients (DIOPP), Service de Réanimation, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Guisset
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Léa Bientz
- Laboratoire de Bactériologie, CHU de Bordeaux; Microbiologie Fondamentale et Pathogénicité UMR5234, Université de Bordeaux, Bordeaux, France
| | - Pierre Khan
- Département d'Anesthésie Réanimation Sud, Centre Médico-Chirurgical Magellan, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Vivien Guillotin
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, CH Départemental de la Vendée, La Roche-sur-Yon, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
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