背景:最近的警报强调,自2022年以来,欧洲和美国的A组链球菌(GAS)感染有所增加。化脓性链球菌可导致局限性皮肤或粘膜疾病,但也可能表现为严重的侵袭性疾病,需要重症监护。我们对自2022年1月以来最近入住比利时重症监护病房(ICU)的GAS感染患者进行了一项多中心回顾性研究。我们描述了患者特征,并调查了所涉及的化脓性链球菌菌株的分子流行病学。
结果:在2022年1月至2023年5月之间,共有86例(56名成年人,30名患有GAS疾病的儿童)在鲁汶大学医院接受了重症监护,安特卫普和列日.我们注意到严重的社区获得性肺炎(sCAP)的发病率非常高(45%的成年人,77%的儿童)在45%和83%的成人和儿科病例中并发脓胸,分别。三分之二的化脓性链球菌肺炎患者有病毒共感染,流感(13名成人,5个孩子)占主导地位。其他疾病表现包括坏死性筋膜炎(23%的成年人),其他严重的皮肤/软组织感染(16%的成年人,13%的儿童)和耳/鼻/喉感染(13%的成年人,13%的儿童)。心源性休克很常见(36%的成年人,20%的儿童)。56例患者(65%)患有中毒性休克综合征。器官支持要求很高,包括有创机械通气(77%的成年人,50%的儿童),肾脏替代疗法(29%的成年人,3%的儿童)和体外膜氧合(20%的成人,7%的儿童)。成人死亡率为21%,儿童死亡率为3%。来自86例患者中55例的化脓性链球菌菌株的基因组分析显示,emm1菌株占主导地位(73%),用产毒M1UK谱系取代了M1global谱系(83%的emm1菌株是M1UK)。
结论:最近严重GAS感染的上升(2022-23)与比利时引入M1UK谱系有关,但其他因素也可能起作用-包括呼吸道病毒的密集循环和COVID大流行后潜在的免疫债务。重要的是,重症监护医师应在sCAP的鉴别诊断中包括化脓性链球菌作为病原体。
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.