title: The increased prevalence of severe necrotizing infections caused by non-group A streptococci.
abstract: The authors report on 20 patients who were admitted to the University of Texas Health Science Center at San Antonio during a recent 4-month period with foot infections caused predominantly by non-group A streptococci. This number of patients was significantly greater than the number admitted to the same institution with the same diagnosis during the preceding 3 years. All patients had type 2 diabetes mellitus. In each case, a rapidly spreading cellulitis followed trauma to the foot, which necessitated emergent incision and drainage. Five patients required extensive fascial and skin debridement because of soft-tissue destruction, and two patients needed below-the-knee amputation because of uncontrolled infection. These cases suggest that non-group A streptococci, like group A streptococci, can cause serious skin and soft-tissue infections in patients with diabetes that may require aggressive surgical debridement despite appropriate antibiotic therapy.
authors.affiliation: Pacific Coast Wound Care, California College of Podiatric Medicine, San Francisco, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Reyzelman
authors.forename: B A
authors.initials: BA
authors.lastname: Lipsky
authors.forename: S A
authors.initials: SA
authors.lastname: Hadi
authors.forename: L B
authors.initials: LB
authors.lastname: Harkless
authors.forename: D G
authors.initials: DG
authors.lastname: Armstrong
mesh_terms: D002481:Cellulitis / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D018409:Foot Injuries / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015995:Prevalence; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D013291:Streptococcus / Q000145:classification; D013781:Texas / Q000453:epidemiology; D014774:Virulence