• Arthur Orieux, Renaud Prevel, Margot Dumery, LascarrouJean-BaptisteJB0000-0003-3706-078XService de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France., Noémie Zucman, Florian Reizine, Pierre Fillatre, Charles Detollenaere, Cédric Darreau, Nadiejda Antier, Mélanie Saint-Léger, Guillaume Schnell, Béatrice La Combe, Charlotte Guesdon, Franklin Bruna, Antoine Guillon, Caroline Varillon, Olivier Lesieur, Hubert Grand, Benjamin Bertrand, Shidasp Siami, Pierre Oudeville, Céline Besnard, Romain Persichini, Pierrick Bauduin, Martial Thyrault, Mathieu Evrard, David Schnell, Johann Auchabie, Adrien Auvet, Jean-Philippe Rigaud, Pascal Beuret, Maxime Leclerc, Asaël Berger, Ben Hadj SalemOmarOService de Réanimation Médico-Chirurgicale, CHI Meulan - les Mureaux, Meulan en Yvelines, France., Julien Lorber, Annabelle Stoclin, Olivier Guisset, Léa Bientz, Pierre Khan, Vivien Guillotin, Jean-Claude Lacherade, Alexandre Boyer, ISTRE Group, LascarrouJean-BaptisteJB, and Ben Hadj SalemOmarO.
• Service de Médecine Intensive Réanimation, Hôpital Pellegrin et Hôpital Saint André, CHU de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France. arthur.orieux@chu-bordeaux.fr.
• Crit Care. 2024 Jan 2; 28 (1): 44.

BackgroundGroup A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients' characteristics, and determine ICU mortality associated factors.MethodsWe performed a retrospective multicenter cohort study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center's microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate.ResultsTwo hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively (p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients (n = 222) had a median SOFA score of 8 (5-13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71-21.60), p = 0.005), STSS (OR = 5.75 (1.71-19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05-22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03-15.59), p = 0.044), and diabetes (OR = 3.92 (1.42-10.79), p = 0.008) were significantly associated with ICU mortality.ConclusionThe incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.© 2023. The Author(s).

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