• Clin. Infect. Dis. · Jan 2021

    Multicenter Study

    Risk factors and Predictors of Mortality in Streptococcal Necrotizing Soft-Tissue Infections: A Multicenter Prospective Study.

    • Trond Bruun, Eivind Rath, Martin Bruun Madsen, Oddvar Oppegaard, Michael Nekludov, Per Arnell, Ylva Karlsson, Anshu Babbar, Francois Bergey, Andreas Itzek, Ole Hyldegaard, Anna Norrby-Teglund, Steinar Skrede, and INFECT Study Group.
    • Department of Medicine, Haukeland University Hospital, Bergen, Norway.
    • Clin. Infect. Dis. 2021 Jan 27; 72 (2): 293-300.

    BackgroundNecrotizing soft-tissue infections (NSTI) are life-threatening conditions often caused by β-hemolytic streptococci, group A Streptococcus (GAS) in particular. Optimal treatment is contentious. The INFECT cohort includes the largest set of prospectively enrolled streptococcal NSTI cases to date.MethodsFrom the INFECT cohort of 409 adults admitted with NSTI to 5 clinical centers in Scandinavia, patients culture-positive for GAS or Streptococcus dysgalactiae (SD) were selected. Risk factors were identified by comparison with a cohort of nonnecrotizing streptococcal cellulitis. The impact of baseline factors and treatment on 90-day mortality was explored using Lasso regression. Whole-genome sequencing of bacterial isolates was used for emm typing and virulence gene profiling.ResultsThe 126 GAS NSTI cases and 27 cases caused by SD constituted 31% and 7% of the whole NSTI cohort, respectively. When comparing to nonnecrotizing streptococcal cellulitis, streptococcal NSTI was associated to blunt trauma, absence of preexisting skin lesions, and a lower body mass index. Septic shock was significantly more frequent in GAS (65%) compared to SD (41%) and polymicrobial, nonstreptococcal NSTI (46%). Age, male sex, septic shock, and no administration of intravenous immunoglobulin (IVIG) were among factors associated with 90-day mortality. Predominant emm types were emm1, emm3, and emm28 in GAS and stG62647 in SD.ConclusionsStreptococcal NSTI was associated with several risk factors, including blunt trauma. Septic shock was more frequent in NSTI caused by GAS than in cases due to SD. Factors associated with mortality in GAS NSTI included age, septic shock, and no administration of IVIG.© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

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