1
|
Jayakumar JS, Niyas VKM, Arjun R. Group A Streptococcal Bacteremia: Ten Years’ Experience from a Tertiary Care Center in South India. Indian J Crit Care Med 2022; 26:1019-1021. [PMID: 36213703 PMCID: PMC9492746 DOI: 10.5005/jp-journals-10071-24306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patients and methods Results Conclusion How to cite this article
Collapse
Affiliation(s)
- Jeethu Sreekala Jayakumar
- Department of Internal Medicine, Kerala Institute of Medical Sciences/KIMSHEALTH, Thiruvananthapuram, Kerala, India
| | - Vettakkara Kandy Muhammed Niyas
- Department of Infectious Diseases, Kerala Institute of Medical Sciences/KIMSHEALTH, Thiruvananthapuram, Kerala, India
- Vettakkara Kandy Muhammed Niyas, Department of Infectious Diseases, Kerala Institute of Medical Sciences/KIMSHEALTH, Thiruvananthapuram, Kerala, India, Phone: +91 9446218291, e-mail:
| | - Rajalakshmi Arjun
- Department of Infectious Diseases, Kerala Institute of Medical Sciences/KIMSHEALTH, Thiruvananthapuram, Kerala, India
| |
Collapse
|
2
|
|
3
|
Megged O, Yinnon AM, Raveh D, Rudensky B, Schlesinger Y. Group A streptococcus bacteraemia: comparison of adults and children in a single medical centre. Clin Microbiol Infect 2006; 12:156-62. [PMID: 16441454 DOI: 10.1111/j.1469-0691.2005.01311.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Group A streptococcus (GAS) bacteraemia is often associated with soft-tissue infection, with significant morbidity and mortality. Little is known concerning the differences between adults and children with GAS bacteraemia. Records for 98 of 116 cases of GAS bacteraemia (60 adults and 38 children, aged 7 days to 96 years) occurring during a 10-year period (1993-2002) were located and reviewed. GAS bacteraemia comprised 0.6% of all bacteraemias in adults, compared to 3.3% in children (p < 0.001). The rate of adult GAS bacteraemia was two cases/1000 hospitalisations, compared to 13/1000 in children (p < 0.001). Seventy-six (78%) patients had concomitant tissue involvement, with skin or soft-tissue infection being the most common (62%). Fifty-three (88%) of 60 adults and five (13%) of 38 children had underlying conditions (p < 0.001). Twelve patients died, only one of whom was a child. Parameters associated with mortality were older age, lower temperature, hypotension, a need for surgical intervention, toxic shock syndrome, disseminated intravascular coagulation, thrombocytopenia, lymphopenia, hypocalcaemia, renal failure and acidosis (p < 0.05).
Collapse
Affiliation(s)
- O Megged
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
4
|
Daneman N, McGeer A, Low DE, Tyrrell G, Simor AE, McArthur M, Schwartz B, Jessamine P, Croxford R, Green KA. Hospital-acquired invasive group a streptococcal infections in Ontario, Canada, 1992-2000. Clin Infect Dis 2005; 41:334-42. [PMID: 16007530 DOI: 10.1086/431589] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 03/07/2005] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A significant proportion of invasive group A streptococcal infections are hospital acquired. No large, prospective studies have characterized this subgroup of cases and evaluated the risk of transmission in hospitals. METHODS We conducted prospective, population-based surveillance of invasive group A streptococcal infections in Ontario, Canada, from 1992 to 2000. Epidemiologic and microbiologic investigations were conducted to identify cross-transmission. RESULTS We identified 291 hospital-acquired cases (12.4%) among 2351 cases of invasive group A streptococcal disease. Hospital-acquired invasive group A streptococcal infections are heterogeneous, including surgical site (96 cases), postpartum (86 cases), and nonsurgical, nonobstetrical infections (109 cases). Surgical site infections affected 1 of 100,000 surgical procedures and involved all organ systems. Postpartum infections occurred at a rate of 0.7 cases per 10,000 live births and exhibited an excellent prognosis. Nonsurgical, nonobstetrical infections encompassed a broad range of infectious syndromes (case-fatality rate, 37%). Nine percent of cases were associated with in-hospital transmission. Transmission occurred from 3 of 142 patients with community-acquired cases of necrotizing fasciitis requiring intensive care unit (ICU) admission, compared with 1 of 367 patients with community-acquired cases without necrotizing fasciitis admitted to the ICU and 1 of 1551 patients with other cases (P<.001). Fifteen outbreaks were identified; 9 (60%) involved only 2 cases. Hospital staff were infected in 1 of 15 outbreaks, but colonized staff were identified in 6 (60%) of 10 investigations in which staff were screened. CONCLUSIONS Presentation of hospital-associated invasive group A streptococcal infections is diverse. Cross-transmission is common; illness occurs in patients but rarely in staff. Isolation of new cases of necrotizing fasciitis and intervention after a single nosocomial case may also prevent transmission.
Collapse
Affiliation(s)
- N Daneman
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Cohen-Poradosu R, Jaffe J, Lavi D, Grisariu-Greenzaid S, Nir-Paz R, Valinsky L, Dan-Goor M, Block C, Beall B, Moses AE. Group G streptococcal bacteremia in Jerusalem. Emerg Infect Dis 2004; 10:1455-60. [PMID: 15496248 PMCID: PMC3320404 DOI: 10.3201/eid1008.030840] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recurrent group G Steptococcus bacteremia, associated with lymphatic disorders and possibly emmstG840.0, is described. Group G Streptococcus (GGS) can cause severe infections, including bacteremia. These organisms often express a surface protein homologous to the Streptococcus pyogenes M protein. We retrospectively studied the characteristics of patients from the Hadassah Medical Center with GGS bacteremia from 1989 to 2000. Ninety-four cases of GGS bacteremia were identified in 84 patients. The median age was 62 years, 54% were males, and 92% had underlying diseases (35% had a malignancy, and 35% had diabetes mellitus). The most frequent source for bacteremia was cellulitis (61%). emm typing of 56 available isolates disclosed 13 different types, including 2 novel types. Six patients had recurrent bacteremia with two to four bacteremic episodes, five had chronic lymphatic disorders, and two had emm type stG840.0 in every episode. Recurrent bacteremia has not been described for invasive group A Streptococcus. We describe an entity of recurrent GGS bacteremia, which is associated with lymphatic disorders and possibly with emm stG840.0.
Collapse
Affiliation(s)
| | - Joseph Jaffe
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Lavi
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ran Nir-Paz
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lea Valinsky
- Ministry of Health Central Laboratory, Jerusalem, Israel
| | - Mary Dan-Goor
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Colin Block
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allon E. Moses
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
6
|
Moses AE, Goldberg S, Korenman Z, Ravins M, Hanski E, Shapiro M. Invasive group a streptococcal infections, Israel. Emerg Infect Dis 2002; 8:421-6. [PMID: 11971778 PMCID: PMC2730245 DOI: 10.3201/eid0804.010278] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We conducted a prospective, nationwide, population-based study of invasive group A streptococcal infections in Israel. We identified 409 patients (median age 27 years; range <1-92), for an annual incidence of 3.7/100,000 (11/100,000 in Jerusalem). The mortality rate was 5%. Bacteremia occurred in 125 cases (31%). The most common illnesses were soft-tissue infection (63%) and primary bacteremia (14%). Thirty percent of patients had no identifiable risk factors for infection. Eighty-seven percent of pharyngeal carriers had the same serotype as the index patient. M types included M3 (25%), M28 (10%), and M-nontypable (33%). A marked paucity of M1 serotype (1.2%) was detected. The results highlighted concentrated pockets of invasive disease in the Jewish orthodox community (annual incidence 16/100,000).
Collapse
Affiliation(s)
- Allon E Moses
- Hadassah University Medical Center, Jerusalem, Isreal.
| | | | | | | | | | | |
Collapse
|
7
|
Bernaldo de Quirós JC, Moreno S, Cercenado E, Diaz D, Berenguer J, Miralles P, Catalán P, Bouza E. Group A streptococcal bacteremia. A 10-year prospective study. Medicine (Baltimore) 1997; 76:238-48. [PMID: 9279330 DOI: 10.1097/00005792-199707000-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this paper we present a prospective evaluation of 100 patients with Group A Streptococcal (GAS) bacteremia evaluated in our hospital over a 10-year period. Sixty-two patients were intravenous drug users (IVDU); all but 1 of these had an obvious cutaneous portal of entry related to the injection of illicit drugs. Twenty-seven patients had infectious metastasis, and the presence of septic pulmonary embolism was associated with suppurative phlebitis. Four of these patients had endocarditis. In the non-IVDU group, 24 patients had an underlying disease, and 12 were immunosuppressed. In 14 cases the infection was of hospital acquisition; in 35% infection was related to medical manipulations. Comparing the IVDU and non-IVDU groups, GAS bacteremia in IVDU patients is associated with a more benign outcome, a longer time of evolution before diagnosis, and a lower frequency of septic shock and mortality than in non-IVDU patients. Although in the univariate analysis GAS bacteremia was associated with several variables, in the multivariate analysis only the presence of shock and nosocomial acquisition of the infection were independently associated with a fatal outcome. Fifty-two patients were infected with human immunodeficiency virus (HIV); 5 of these were in the non-IVDU group. During the last 5 years of study, GAS bacteremia in our hospital was 39 times more frequent in HIV-infected patients than in patients without HIV. Nine patients presented clinical criteria corresponding to Streptococcal toxic shock syndrome (STSS), although its incidence was lower in the IVDU group. In the non-IVDU group, STSS was more frequent in patients with a necrotizing portal of entry, an age between 20 and 40 years, women, and when the origin of the infection was the skin or soft tissue. Six patients with STSS died, and death was associated with the presence of necrotizing lesions and lower counts of white cells, platelets, or hemoglobin.
Collapse
Affiliation(s)
- J C Bernaldo de Quirós
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Weiss I, Gorodnitzky Z, Korenman Z, Yagupsky P. Serotyping and susceptibility to macrolides and other antimicrobial drugs of Streptococcus pyogenes isolated from patients with invasive diseases in southern Israel. Eur J Clin Microbiol Infect Dis 1997; 16:20-3. [PMID: 9063669 DOI: 10.1007/bf01575115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fifty-seven strains of Streptococcus pyogenes isolated from septic patients and 52 isolates from nonbacteremic patients in southern Israel were investigated for their susceptibility to new macrolides and other antimicrobial drugs. In addition, typing of the isolates by M protein and T antigen was performed. All organisms were susceptible to penicillin and chloramphenicol, 59% to tetracycline, and 7% to trimethoprim-sulfamethoxazole. All isolates but one (99%) were susceptible to clarithromycin, azithromycin, erythromycin, and clindamycin. The MIC90 of clarithromycin, erythromycin, and clindamycin was 0.064, 0.125, and 0.094 microgram/ml, respectively. Overall, 96% of the isolates could be typed by T antigen, but only 43% were M-protein typeable. No predominance of any particular M-protein type was observed. No significant differences between blood isolates and organisms derived from other sources were observed in the antibiotic susceptibility patterns or the distribution of serotypes. It is concluded that invasive Streptococcus pyogenes infections in southern Israel are caused by multiple unrelated strains. The organism remains susceptible to macrolides and clindamycin.
Collapse
Affiliation(s)
- I Weiss
- Clinical Microbiology Laboratories, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | |
Collapse
|
9
|
Livni G, Ashkenazi S, Leibovici L, Pitlik S, Lev B, Konisberger H, Samra Z, Drucker M. Incidence and severity of group A streptococcal bacteremia in a medical center in Israel, 1981-1994. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1996; 28:139-42. [PMID: 8792479 DOI: 10.3109/00365549609049064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To determine recent trends in the incidence and severity, group A streptococcal (GAS) bacteremia was studied over the last 14 years (1981-1994). There were 116 events of GAS bacteremia, representing 1.7% of all bacteremic episodes, without an increase in recent years. A total of 108 patients were available for study. Underlying conditions were found in 95 patients (88%), including mainly malignant diseases, chronic obstructive pulmonary disease, congestive heart failure and diabetes mellitus. A source of the bacteremia was noted in 71 patients (66%), with skin and soft tissue infection being the major portal of entry. All isolates were susceptible to penicillin. Overall mortality was 21%. Mortality had not increased in recent years, but depended significantly on several clinical factors: increased age; admission temperature; source of bacteremia (highest for GAS bacteremia without an identified source); and underlying conditions (highest for diabetes mellitus and chronic pulmonary disease, absent for patients with no underlying disease). This study shows that neither the incidence nor the severity of GAS bacteremia has increased in recent years. Severity is significantly affected by the source of bacteremia and the presence of underlying conditions.
Collapse
Affiliation(s)
- G Livni
- Department of Pediatrics, Schneider Children's Medical Center, Petah Tiqva, Israel
| | | | | | | | | | | | | | | |
Collapse
|