Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series.
Community-acquired pneumonia; Critical care; Empyema; Group A streptococci; Influenza; Invasive; Necrotizing fasciitis; Streptococcus pyogenes; Toxic shock syndrome; Viral coinfection; Critical Care and Intensive Care Medicine
Abstract :
[en] [en] BACKGROUND: Recent alerts have highlighted an increase in group A streptococcal (GAS) infections since 2022 in Europe and the United States. Streptococcus pyogenes can cause limited skin or mucosal disease, but can also present as severe invasive disease necessitating critical care. We performed a multicenter retrospective study of patients with GAS infections recently admitted to Belgian intensive care units (ICUs) since January 2022. We describe patient characteristics and investigate the molecular epidemiology of the S. pyogenes strains involved.
RESULTS: Between January 2022 and May 2023, a total of 86 cases (56 adults, 30 children) with GAS disease were admitted to critical care in the university hospitals of Leuven, Antwerp and Liège. We noted a strikingly high incidence of severe community-acquired pneumonia (sCAP) (45% of adults, 77% of children) complicated with empyema in 45% and 83% of adult and pediatric cases, respectively. Two-thirds of patients with S. pyogenes pneumonia had viral co-infection, with influenza (13 adults, 5 children) predominating. Other disease presentations included necrotizing fasciitis (23% of adults), other severe skin/soft tissue infections (16% of adults, 13% of children) and ear/nose/throat infections (13% of adults, 13% of children). Cardiogenic shock was frequent (36% of adults, 20% of children). Fifty-six patients (65%) had toxic shock syndrome. Organ support requirements were high and included invasive mechanical ventilation (77% of adults, 50% of children), renal replacement therapy (29% of adults, 3% of children) and extracorporeal membrane oxygenation (20% of adults, 7% of children). Mortality was 21% in adults and 3% in children. Genomic analysis of S. pyogenes strains from 55 out of 86 patients showed a predominance of emm1 strains (73%), with a replacement of the M1global lineage by the toxigenic M1UK lineage (83% of emm1 strains were M1UK).
CONCLUSIONS: The recent rise of severe GAS infections (2022-23) is associated with introduction of the M1UK lineage in Belgium, but other factors may be at play-including intense circulation of respiratory viruses and potentially an immune debt after the COVID pandemic. Importantly, critical care physicians should include S. pyogenes as causative pathogen in the differential diagnosis of sCAP.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Peetermans, Marijke ✱; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. marijke.peetermans@uzleuven.be ; Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. marijke.peetermans@uzleuven.be
Matheeussen, Veerle ✱; Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium ; Laboratory of Medical Biochemistry and Laboratory of Medical Microbiology, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
Moerman, Cedric; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium ; Department of Anesthesiology and Critical Care Medicine, GZA Hospital Group, Antwerp, Belgium
De Rydt, Fréderic; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium ; Department of Anesthesiology, Chirec Hospitals, Brussels, Belgium
Thieren, Sabine; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium ; Department of Anesthesiology, VITAZ Hospital, Sint-Niklaas, Belgium
Pollet, Emily; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
Casaer, Michael ; Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium ; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
De Backer, Benjamin; Service de Microbiologie Clinique, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
De Paep, Rudi; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
Debaveye, Yves ; Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium ; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Desmet, Lars ; Pediatric Intensive Care Unit, Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
Desmet, Stefanie ; Laboratory for Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Duval, Els I M; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
Fraipont, Vincent ; Service des Soins Intensifs, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
Geysels, Dieter ; Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
Hermans, Greet ; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
Lahaye, Frederik; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
Mathy, Xavier; Service des Soins Intensifs, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
Meersseman, Philippe ; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
Meex, Cécile ; Centre Hospitalier Universitaire de Liège - CHU > > Service de microbiologie clinique
Van Herck, Jozef; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
van Kleef-van Koeveringe, Stefanie ; Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
Layios, Nathalie ✱; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Wauters, Joost ✱; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium ; Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Jorens, Philippe G ✱; Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium ; Department of Medicine and Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
✱ These authors have contributed equally to this work.
Language :
English
Title :
Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series.
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