Invasive group A streptococcal infections in adults, France (2006–2010)

Authors

  • C. Plainvert,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
    2. ) Faculté de Médecine, Université Paris Descartes, Paris
    3. ) INSERM 1016, Institut Cochin, Paris
    4. ) CNRS, UMR8104, Paris
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  • A. Doloy,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
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  • J. Loubinoux,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
    2. ) Faculté de Médecine, Université Paris Descartes, Paris
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  • A. Lepoutre,

    1. ) Département des Maladies Infectieuses, Institut de Veille Sanitaire, St Maurice
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  • G. Collobert,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
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  • G. Touak,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
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  • P. Trieu-Cuot,

    1. ) Unité de Biologie des Bactéries Pathogènes à Gram-positif URA CNRS 2172, Institut Pasteur, Paris
    2. ) Laboratoire Associé au CNR-Strep, Institut Pasteur, Paris, France
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  • A. Bouvet,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
    2. ) Faculté de Médecine, Université Paris Descartes, Paris
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  • C. Poyart,

    1. ) Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris
    2. ) Faculté de Médecine, Université Paris Descartes, Paris
    3. ) INSERM 1016, Institut Cochin, Paris
    4. ) CNRS, UMR8104, Paris
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  • on behalf of the CNR-Strep network


Corresponding author: Professor C. Poyart, Service de Bactériologie, Centre National de Référence des Streptocoques, Groupe Hospitalier Cochin-Hôtel Dieu-Broca, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
E-mail: claire.poyart@cch.aphp.fr

Abstract

Clin Microbiol Infect 2012; 18: 702–710

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.

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