Invasive Group A Streptococcal Infections in Adults, France (2006-2010)

Clin Microbiol Infect. 2012 Jul;18(7):702-10. doi: 10.1111/j.1469-0691.2011.03624.x. Epub 2011 Aug 29.

Abstract

Severe invasive group A streptococcal diseases have re-emerged during the past 10-20 years. In order to provide a better insight into the current epidemiological situation in France, we analysed the questionnaires regarding all invasive strains received at the National Reference Center for Streptococci (CNR-Strep) between 2006 and 2010 from patients aged ≥ 18 and characterized them by emm typing, spe gene detection and antibiotic resistance. Among the 1542 invasive GAS strains studied, 78% (n=1206) were from blood cultures, and a streptococcal toxic shock syndrome (STSS) was described in 22% (n=340) of cases, mainly associated with necrotizing fasciitis (NF) and pleuro-pulmonary infections (p<0.001). The in-hospital fatality rate was 15%. A total of 83 different emm types were recovered but the three predominant emm types, representing almost 60% of the isolates, were emm1 (24%), emm28 (17%) and emm89 (15%). The preponderance of each emm type varied according to the year, with a significant constant increase of emm28 strains, whereas emm1 strains, representing approximately 32% of GAS invasive isolates in 2007 and 2008, dropped to <15% in 2010 (p<0.001). The distribution of phage-associated superantigen genes (speA, speC and ssa) was linked to certain emm types. Between 2006 and 2010, the percentage that was macrolide-resistant decreased from 11% to 5%, confirming the trend observed in 2007. Fortunately, emm1 strains associated with the most life-threatening clinical manifestations remain susceptible to all anti-streptococcal antibiotics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Bacteremia / mortality
  • Drug Resistance, Bacterial
  • Fasciitis, Necrotizing / epidemiology
  • Fasciitis, Necrotizing / microbiology
  • Fasciitis, Necrotizing / mortality
  • Female
  • France / epidemiology
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Molecular Typing
  • Pleuropneumonia / epidemiology
  • Pleuropneumonia / microbiology
  • Pleuropneumonia / mortality
  • Prevalence
  • Shock, Septic / epidemiology
  • Shock, Septic / microbiology
  • Shock, Septic / mortality
  • Streptococcal Infections / epidemiology*
  • Streptococcal Infections / microbiology*
  • Streptococcal Infections / mortality
  • Streptococcus pyogenes / classification
  • Streptococcus pyogenes / drug effects
  • Streptococcus pyogenes / genetics
  • Streptococcus pyogenes / isolation & purification*
  • Young Adult

Substances

  • Anti-Bacterial Agents