Beta-Hemolytic Streptococci and Necrotizing Soft Tissue Infections
Trond Bruun1,2, Eivind Rath3, Oddvar Oppegaard3
1Department of Clinical Science, University of Bergen, Bergen, Norway. trond.bruun@helse-bergen.no.
Advances in Experimental Medicine and Biology
|October 20, 2020
Summary
Necrotizing soft tissue infections (NSTIs) caused by Streptococcus pyogenes (GAS) and Streptococcus dysgalactiae (SD) are severe. Blunt trauma, lack of skin lesions, and lower BMI are risk factors for these infections, with IVIG improving survival.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- β-hemolytic streptococci, particularly Streptococcus pyogenes (group A streptococcus; GAS), are primary causes of necrotizing soft tissue infections (NSTIs).
- Streptococcus dysgalactiae (SD) also causes NSTIs, though less frequently reported.
- Risk factors differentiating streptococcal NSTIs from cellulitis were not well-established.
Purpose of the Study:
- To investigate the clinical characteristics, risk factors, and outcomes of NSTIs caused by GAS and SD.
- To evaluate the effectiveness of intravenous immunoglobulin (IVIG) in treating streptococcal NSTIs.
- To analyze microbial diversity and identify predominant emm types in streptococcal NSTIs.
Main Methods:
- Analysis of the INFECT cohort, comprising 409 patients with NSTIs.
- Comparison of risk factors between NSTIs and streptococcal cellulitis.
- Assessment of outcomes, including septic shock and mortality, and the impact of IVIG treatment.
Main Results:
- GAS accounted for 31% and SD for 7% of NSTIs in the cohort.
- Blunt trauma, absence of pre-existing skin lesions, and lower BMI were identified as risk factors for NSTIs.
- Septic shock was more frequent in GAS cases and predicted mortality; IVIG treatment was associated with increased survival.
Conclusions:
- Streptococcal NSTIs, particularly those caused by GAS, are severe infections with identifiable risk factors.
- IVIG may improve survival rates in patients with streptococcal NSTIs.
- Further research is needed for novel diagnostics and improved treatments for these serious infections.
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