Epidemiology of invasive group A streptococcal infections in Norway 2010–2014: A retrospective cohort study

Naseer, Umaer; Steinbakk, Martin; Blystad, Hans; Caugant, Dominique A.

doi:10.1007/s10096-016-2704-y

Cited by 66 publications

(40 citation statements)

References 29 publications

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“…In the present study, the resistance rates of S. pyogenes strains to clindamycin and erythromycin were up to 81.8%, which was significantly higher than that in other countries (4-54%). [16][17][18] This finding is consistent with a previous report in China that showed a >90% erythromycin resistance rate. 19 Based on these results, we suggest that macrolide antibiotics should not be the choice of treatment for Chinese iSPI patients, even when patients are allergic to β-lactam antibiotics.…”

Section: Discussionsupporting

confidence: 92%

Analysis of 11 Cases of Neonatal Invasive Streptococcus pyogenes Infection

Xie

Chen

et al. 2020

Journal of Pediatric Infectious Diseases

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Objective This study aimed to improve the understanding of clinical characteristics of neonatal invasive Streptococcus pyogenes infection (iSPI). Methods A retrospective study was performed to analyze the clinical and laboratory aspects of culture-confirmed neonatal iSPI cases during 2010 to 2017. Results Eleven cases of neonatal iSPI were confirmed. The ages ranged from 2 hours to 26 days. Ten cases had positive blood culture results and one had positive cerebrospinal fluid culture for S. pyogenes. Seven patients had fever and seven had identified focal infection, including six skin and soft tissue infections and one case of pneumonia. All of the S. pyogenes strains were sensitive to penicillin, cefotaxime, and vancomycin, and nine were resistant to clindamycin and erythromycin. Six patients received penicillin or cephalosporin monotherapy. Three patients received meropenem plus vancomycin initially, and then two of them were switched to penicillin and one to vancomycin after pathogen identification. Two cases were treated with vancomycin monotherapy. All cases were discharged after being cured or showing improvement. Conclusion Skin and soft tissue infection is a common manifestation of neonatal iSPI. Streptococcus pyogenes strains are highly sensitive to β-lactams, which should be used as the first-choice treatment.

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Section: Discussionsupporting

confidence: 92%

Analysis of 11 Cases of Neonatal Invasive Streptococcus pyogenes Infection

Xie

Chen

et al. 2020

Journal of Pediatric Infectious Diseases

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“…Incidence rates of invasive infections with single microbes have been reported [29–33], but no population-based study has focused on BSI as a whole. One previous study described the epidemiology of sepsis in Norway in 1999 [34], and two studies published more than 20 years ago [26, 35] described BSI incidence and mortality related to hospital admissions and bed-days, but did not include population statistics.…”

Section: Discussionmentioning

confidence: 99%

Burden of bloodstream infection in an area of Mid-Norway 2002-2013: a prospective population-based observational study

et al. 2017

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BackgroundStudies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time.MethodsWe studied the burden of disease and death related to BSI in a defined geographical area of Mid-Norway, where BSI episodes were prospectively recorded by the same microbiological department during 12 consecutive years. Death from BSI was defined as death within 30 days of BSI detection. Age and sex standardized incidence and mortality rates and case fatality rates were calculated.ResultsBetween 2002 and 2013, 1995 episodes of BSI in 1719 patients aged 16 to 99 years were included. The overall incidence of BSI was 215 per 100,000 person-years. The incidence increased exponentially with age, particularly in males. The incidence increased from 205 to 223 per 100,000 person-years from 2002–07 to 2008–13. Escherichia coli was the most frequently isolated infective agent, followed by Streptococcus pneumoniae and Staphylococcus aureus. The rate of S. pneumoniae BSI decreased over time in males (on average by 9.2% annually), but not in females. The total rate of BSI microbes with acquired resistance increased slightly over time, but did not exceed 2 episodes per 100,000 person-years. The mortality of BSI was 32 per 100,000 person-years, higher in males than in females (36 vs. 28 per 100,000 person-years) and was significantly higher in old age, particularly in males. The total BSI mortality was similar in the first and second halves of the study period, but the mortality of S. pneumoniae BSI decreased in males (15.0% annually). The crude case fatality decreased from the first to the second half of the study period (17.2% to 13.1%; p = 0.014). The rate of blood culture sampling increased more than twofold during the study period.ConclusionsThe mortality of BSI remained stable during 2002–2013. At the same time, BSI incidence increased and case fatality rate decreased, perhaps because an increased rate of blood culture sampling may have led to improved detection of milder BSI episodes. Very low, yet slightly increasing rates of microbes with acquired resistance were observed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2291-2) contains supplementary material, which is available to authorized users.

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“…GAS has been classified historically based on sequence variation in the emm gene encoding M protein, a cell-surface molecule that is antiphagocytic and an important virulence factor (3). Whereas the majority of invasive infections in North America and Europe are caused by a relatively small number of emm types, for example, emm1, emm3, emm12, and emm28 (4)(5)(6)(7)(8)(9)(10)(11), strains of these serotypes are relatively rare in high-disease-burden, low-income regions. Despite a century of effort by many investigators, there is no licensed vaccine available to protect humans against GAS disease.…”

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confidence: 99%

New Pathogenesis Mechanisms and Translational Leads Identified by Multidimensional Analysis of Necrotizing Myositis in Primates

Kachroo

Eraso

Olsen

et al. 2020

mBio

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A fundamental goal of contemporary biomedical research is to understand the molecular basis of disease pathogenesis and exploit this information to develop targeted and more-effective therapies. Necrotizing myositis caused by the bacterial pathogen Streptococcus pyogenes is a devastating human infection with a high mortality rate and few successful therapeutic options. We used dual transcriptome sequencing (RNA-seq) to analyze the transcriptomes of S. pyogenes and host skeletal muscle recovered contemporaneously from infected nonhuman primates. The in vivo bacterial transcriptome was strikingly remodeled compared to organisms grown in vitro, with significant upregulation of genes contributing to virulence and altered regulation of metabolic genes. The transcriptome of muscle tissue from infected nonhuman primates (NHPs) differed significantly from that of mock-infected animals, due in part to substantial changes in genes contributing to inflammation and host defense processes. We discovered significant positive correlations between group A streptococcus (GAS) virulence factor transcripts and genes involved in the host immune response and inflammation. We also discovered significant correlations between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness, as assessed by previously conducted genome-wide transposon-directed insertion site sequencing (TraDIS). By integrating the bacterial RNA-seq data with the fitness data generated by TraDIS, we discovered five new pathogen genes, namely, S. pyogenes 0281 (Spy0281 [dahA]), ihk-irr, slr, isp, and ciaH, that contribute to necrotizing myositis and confirmed these findings using isogenic deletion-mutant strains. Taken together, our study results provide rich new information about the molecular events occurring in severe invasive infection of primate skeletal muscle that has extensive translational research implications. IMPORTANCE Necrotizing myositis caused by Streptococcus pyogenes has high morbidity and mortality rates and relatively few successful therapeutic options. In addition, there is no licensed human S. pyogenes vaccine. To gain enhanced understanding of the molecular basis of this infection, we employed a multidimensional analysis strategy that included dual RNA-seq and other data derived from experimental infection of nonhuman primates. The data were used to target five streptococcal genes for pathogenesis research, resulting in the unambiguous demonstration that these genes contribute to pathogen-host molecular interactions in necrotizing infections. We exploited fitness data derived from a recently conducted genome-wide transposon mutagenesis study to discover significant correlation between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness. Collectively, our findings have significant implications for translational research, potentially including vaccine efforts.

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Epidemiology of invasive group A streptococcal infections in Norway 2010–2014: A retrospective cohort study

Cited by 66 publications

References 29 publications

Analysis of 11 Cases of Neonatal Invasive Streptococcus pyogenes Infection

Analysis of 11 Cases of Neonatal Invasive Streptococcus pyogenes Infection

Burden of bloodstream infection in an area of Mid-Norway 2002-2013: a prospective population-based observational study

New Pathogenesis Mechanisms and Translational Leads Identified by Multidimensional Analysis of Necrotizing Myositis in Primates

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