Group A streptococcal bacteremias in Southwest Finland 2007–2018: epidemiology and role of infectious diseases consultation in antibiotic treatment selection

Abstract

The incidence of invasive group A streptococcal (GAS) infections has shown a fluctuating but increasing trend in Finland. The impact of infectious diseases specialist consultation (IDSC) on the antimicrobial therapy of GAS bacteremia has not been studied earlier. A retrospective study on adult GAS bacteremia in The Hospital District of Southwest Finland (HDSWF) was conducted from 2007 to 2018. Data on incidence of bacteremic GAS cases were gathered from the National Infectious Disease Register. Clinical data were obtained by reviewing the electronic patient records. The overall incidence of GAS bacteremia in HDSWF was 3.52/100,000, but year-to-year variation was observed with the highest incidence of 7.93/100,000 in 2018. A total of 212 adult GAS bacteremia cases were included. A record of IDSC was found (+) in 117 (55.2%) cases, not found (−) in 71 (33.5%) cases and data were not available in 24 (11.3%) cases. Among IDSC+ cases, 57.3% were on penicillin G treatment whereas in the group IDSC− only 22.5%, respectively (OR = 4.61, 95% CI 2.37-8.97; p < 0.001). The use of clindamycin as adjunctive antibiotic was more common among IDSC+ (54.7%) than IDSC− (21.7%) (OR = 4.51, 95% CI 2.29-8.87; p < 0.001). There was an increasing trend in incidence of GAS bacteremia during the study period. Narrow-spectrum beta-lactam antibiotics were chosen, and adjunctive clindamycin was more commonly used, if IDSC took place. This highlights the importance of availability of IDSC but calls for improved practice among infectious diseases specialists by avoiding combination therapy with clindamycin in nonsevere invasive GAS infections.

Invasive beta-haemolytic streptococcal infections, Finland, 2006 to 2020: increase in Lancefield group C/G infections

“…The mean annual incidence rate of iGAS was 4.1 (range: 2.1-6.7) per 100,000 population. This is in line with earlier reports, both from Finland [11][12][13][14] and worldwide [1,[15][16][17][18]. However, our calculated incidence lies at the upper end of the reported spectrum, which reflects the increase in incidence over the study period, at a relative annual increase rate of 3%.…”

“…However, our calculated incidence lies at the upper end of the reported spectrum, which reflects the increase in incidence over the study period, at a relative annual increase rate of 3%. A growing trend in iGAS in Finland has been noted previously [13,14]. Reports from other countries have been varying in this respect, with some studies reporting increasing [18] and others stable or even decreasing trends [15,19].…”

Severe acute otitis media and mastoiditis caused by group A beta‐hemolytic streptococcus

“…At the same time, the number of GAS bacteremia cases increased significantly, as the emm1 type emerged predominantly. 31 , 32 Epidemiology shows that GAS AOM/AM cases usually increase in 7 to 8‐year periods 5 , 24 (Figure 1 ). The last epidemic, with 37 cases treated in a single institution with uniform clinical guidelines of care, offered an exceptional opportunity to characterize severe GAS AOM/AM and its outcome.…”

“… 5 , 21 , 22 , 23 In Finland, the number of invasive GAS infections increased significantly in 2017 compared to previous years (Figure 1 ). 24 During 2017 and 2018, we also noticed a marked increase in patients with severe GAS AOM/AM needing hospital care. Since GAS and diseases caused by it are not fading away in the near future, we set out to describe the current incidence, diagnostics, disease course, and outcome of severe GAS AOM/AM in our hospital setting with special attention given to hearing outcomes.…”

Low rate of asymptomatic carriage and salivary immunoglobulin A response to Group A Streptococci in the healthy adult population in Finland

“…We prepared a pooled lysate of three S. pyogenes strains: MGAS5005 (emm1, ATCC strain BAA-947), MGAS6180 (emm28, ATCC strain BAA-1064), and MGAS27520 (emm89, a Finnish clinical isolate kindly acquired from the Finnish Institute for Health and Welfare) [19]. These strains represent the most common emm types in bacteraemic GAS infections in Finland at current [20,21]. As a control, another pooled lysate was prepared from three common oral streptococcus species: S. mutans (NCTC 10,449), S. salivarius (ATCC 25,975), and S. sanguinis (NCTC 10,904) [22].…”