Increasing Rate of Fatal Streptococcus pyogenes Bacteriemia-A Challenge for Prompt Diagnosis and Appropriate Therapy...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Group A Streptococcus (GAS) bacteremia presents a significant public health challenge due to its high mortality rate.
• Prompt diagnosis and effective antibiotic intervention are critical for managing GAS bacteremia.
• Recent trends indicate a concerning rise in GAS bacteremia incidence and severity.

Purpose of the Study:

• To analyze trends in GAS bacteremia at a university hospital from 2006 to 2024.
• To identify predictors of mortality and clinical outcomes in GAS bacteremia patients.
• To assess antibiotic resistance patterns in *Streptococcus pyogenes* isolates.

Main Methods:

• Retrospective analysis of 93 patients diagnosed with GAS bacteremia.
• Comparison of epidemiological and clinical data between two periods: 2006-2019 and 2020-2024.
• Evaluation of laboratory markers (procalcitonin, lactate, myoglobin) and antibiotic susceptibility.

Main Results:

• GAS bacteremia incidence increased between 2016-2019.
• Mortality significantly rose from 21.9% (2006-2019) to 41.4% (2020-2024), with a reduced time from admission to death (9.5 to 3 days).
• High procalcitonin and lactate levels were significant predictors of worse outcomes in the later period. Myoglobin showed increasing predictive value over time. Penicillin remained effective, while clindamycin resistance decreased.

Conclusions:

• The study highlights a concerning increase in GAS bacteremia mortality and severity post-2020.
• Elevated procalcitonin, lactate, and myoglobin levels are critical indicators for predicting poor prognosis.
• A potential decrease in population immune status may contribute to the observed rise in severe GAS infections.