title: Invasive group A streptococcal infections in adults, France (2006-2010).
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.
authors: Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris, France.
authors: C
authors: C
authors: Plainvert
authors: A
authors: A
authors: Doloy
authors: J
authors: J
authors: Loubinoux
authors: A
authors: A
authors: Lepoutre
authors: G
authors: G
authors: Collobert
authors: G
authors: G
authors: Touak
authors: P
authors: P
authors: Trieu-Cuot
authors: A
authors: A
authors: Bouvet
authors: C
authors: C
authors: Poyart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D011001:Pleuropneumonia / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D015995:Prevalence; D012772:Shock, Septic / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D013297:Streptococcus pyogenes / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents