Analysis of bacteraemia caused by group C and G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) in Western Sydney over a 6-year period (2015-2020).

Publisher: Springer Country of Publication: Germany NLM ID: 8804297 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1435-4373 (Electronic) Linking ISSN: 09349723 NLM ISO Abbreviation: Eur J Clin Microbiol Infect Dis Subsets: MEDLINE

Publication: Berlin : Springer
Original Publication: [Wiesbaden, Federal Republic of Germany] : Vieweg, [c1988-

Bacteremia*/epidemiology ; Bacteremia*/microbiology ; Bacteremia*/mortality ; Streptococcal Infections*/epidemiology ; Streptococcal Infections*/microbiology ; Streptococcal Infections*/mortality ; Streptococcus*/isolation & purification ; Streptococcus*/pathogenicity; Humans ; Aged ; Male ; Middle Aged ; Female ; Retrospective Studies ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Australia/epidemiology ; Comorbidity ; Cross Infection/epidemiology ; Cross Infection/microbiology

Purpose: Streptococcus dysgalactiae subsp. equisimilis (SDSE) has increasingly been recognised as a significant pathogen that causes a myriad of infections, ranging from cellulitis to invasive infections, including bacteraemia and even toxic shock syndrome. The aim of this study was to examine the epidemiology and disease manifestations of bacteraemia caused by SDSE.
Methods: We retrospectively reviewed cases of SDSE bacteraemia in adults aged ≥ 18 years admitted to four public hospitals in Western Sydney, Australia, between January 2015 and December 2020. We reviewed demographics, comorbidities, disease manifestations, management, and outcomes.
Results: There were 108 patients with SDSE bacteraemia over a six-year period. The median age of individuals with SDSE bacteraemia was 70 years (interquartile range, IQR, 58-85 years). Cardiovascular disease (46%), chronic skin conditions (44%) and diabetes (37%) were the most common comorbidities. Ten patients (9%) with SDSE bacteraemia had healthcare-acquired infections. Skin and skin structure infections (SSTIs) were the most common presentations (59%), while bone and joint infections (BJIs) represented 13% of the cases. Twenty patients (19%) had septic shock on presentation. Fifteen patients (14%) were prescribed clindamycin, while one patient received intravenous immunoglobulin (IVIg). Infective endocarditis (IE) was present in 3% of patients; however, only 44% of the total patients had an echocardiogram. The 30-day mortality rate was 13%, but it was greater in those aged > 75 years (21%). The average length of hospital stay for patients who survived was 15 days, and the average duration of intravenous therapy was 12 days.
Conclusion: SDSE bacteraemia is typically a community-onset infection with a fifth of patients in our cohort presenting with septic shock. Though complications such as BJI (13%) and IE (3%) are infrequent, 30-day mortality is high at 21% in those aged > 75 years.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Facklam R (2002) What happened to the Streptococci: overview of taxonomic and nomenclature changes. Clin Microbiol Rev 15:613–630. https://doi.org/10.1128/CMR.15.4.613-630.2002. (PMID: 10.1128/CMR.15.4.613-630.200212364372126867)
Cunningham MW (2000) Pathogenesis of Group A Streptococcal infections. Clin Microbiol Rev 13:470–511. https://doi.org/10.1128/CMR.13.3.470. (PMID: 10.1128/CMR.13.3.4701088598888944)
Walker MJ, Barnett TC, McArthur JD, Cole JN, Gillen CM, Henningham A et al (2014) Disease manifestations and Pathogenic Mechanisms of Group A Streptococcus. Clin Microbiol Rev 27:264–301. https://doi.org/10.1128/CMR.00101-13. (PMID: 10.1128/CMR.00101-13246964363993104)
Haslam DB, St. Geme JW, Groups C (2018) and G Streptococci. Principles and Practice of Pediatric Infectious Diseases :736–737.e1. https://doi.org/10.1016/B978-0-323-40181-4.00122-5.
Baracco GJ (2019) Infections caused by Group C and G Streptococcus (Streptococcus dysgalactiae subsp. Equisimilis and others. Epidemiological and clinical aspects. Gram-positive pathogens. ASM, Washington, DC, USA, pp 275–283. https://doi.org/10.1128/9781683670131.ch17 . (PMID: 10.1128/9781683670131.ch17)
Wessels MR, Sexton DJ, Hall KH (2023) Group C and group G streptococcal infection. UpToDate. https://www.uptodate.com.acs.hcn.com.au/contents/group-c-and-group-g-streptococcal-infection?search=group%20c%20and%20g&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 (accessed March 11, 2023).
Baracco GJ (n.d.) Infections caused by Group C and G Streptococcus (Streptococcus dysgalactiae subsp. Equisimilis and others): epidemiological and clinical aspects. https://doi.org/10.1128/microbiolspec.GPP3.
Xie O, Davies MR, Tong SYC (2024) Streptococcus dysgalactiae subsp. equisimilis infection and its intersection with Streptococcus pyogenes. Clin Microbiol Rev. https://doi.org/10.1128/cmr.00175-23. (PMID: 10.1128/cmr.00175-2338856686)
Oppegaard O, Glambek M, Skutlaberg DH, Skrede S, Sivertsen A, Kittang BR (2023) Streptococcus dysgalactiae Bloodstream infections, Norway, 1999–2021. Emerg Infect Dis 29:260–267. https://doi.org/10.3201/eid2902.221218. (PMID: 10.3201/eid2902.221218366923319881787)
Barros RR Antimicrobial resistance among beta-hemolytic streptococcus in Brazil: an overview. Antibiotics 2021;10. https://doi.org/10.3390/antibiotics10080973.
Lother SA, Demczuk W, Martin I, Mulvey M, Dufault B, Lagacé-Wiens P et al (2017) Clonal clusters and virulence factors of group C and G Streptococcus causing severe infections, Manitoba, Canada, 2012–2014. Emerg Infect Dis 23:1092–1101. https://doi.org/10.3201/eid2307.161259. (PMID: 10.3201/eid2307.161259)
Harris P, Siew DA, Proud M, Buettner P, Norton R (2011) Bacteraemia caused by beta-haemolytic streptococci in North Queensland: changing trends over a 14-year period. Clin Microbiol Infect 17:1216–1222. https://doi.org/10.1111/J.1469-0691.2010.03427.X. (PMID: 10.1111/J.1469-0691.2010.03427.X21073630)
Oppegaard O, Mylvaganam H, Skrede S, Lindemann PC, Kittang BR Emergence of a Streptococcus dysgalactiae subspecies equisimilis stG62647-lineage associated with severe clinical manifestations. Sci Rep 2017;7. https://doi.org/10.1038/s41598-017-08162-z.
Rantala S (2014) Streptococcus dysgalactiae subsp. equisimilis bacteremia: an emerging infection. Eur J Clin Microbiol Infect Dis 33:1303–1310. (PMID: 10.1007/s10096-014-2092-024682845)
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr., Ryan T et al (2000) Proposed modifications to the Duke Criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638. https://doi.org/10.1086/313753. (PMID: 10.1086/31375310770721)
Fowler VG Jr, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL et al (2023) The 2023 Duke-International Society for Cardiovascular Infectious diseases Criteria for Infective endocarditis: updating the modified Duke Criteria. Clin Infect Dis 77:518–526. https://doi.org/10.1093/cid/ciad271. (PMID: 10.1093/cid/ciad2713713844510681650)
Chamat-Hedemand S, Dahl A, Østergaard L, Arpi M, Fosbøl E, Boel J et al (2020) Prevalence of infective endocarditis in Streptococcal Bloodstream infections is dependent on streptococcal species. Circulation 142:720–730. https://doi.org/10.1161/CIRCULATIONAHA.120.046723. (PMID: 10.1161/CIRCULATIONAHA.120.04672332580572)
Ekelund K, Skinhøj P, Madsen J, Konradsen HB (2005) Invasive group A, B, C and G streptococcal infections in Denmark 1999–2002: epidemiological and clinical aspects. Clin Microbiol Infect 11:569–576. https://doi.org/10.1111/j.1469-0691.2005.01169.x. (PMID: 10.1111/j.1469-0691.2005.01169.x15966976)
Broyles LN, Van Beneden C, Beall B, Facklam R, Lynn Shewmaker P, Malpiedi P et al (2009) Population-based study of invasive disease due to β-Hemolytic streptococci of groups other than a and B. Clin Infect Dis 48:706–712. https://doi.org/10.1086/597035. (PMID: 10.1086/59703519187026)
Ruppen C, Rasmussen M, Casanova C, Sendi P (2017) A 10-year observational study of Streptococcus dysgalactiae bacteraemia in adults: frequent occurrence among female intravenous drug users. Swiss Med Wkly 147:w14469. https://doi.org/10.4414/smw.2017.14469. (PMID: 10.4414/smw.2017.1446928750420)
Wright CM, Moorin R, Pearson G, Dyer J, Carapetis J, Manning L (2022) Invasive infections caused by Lancefield Groups C/G and A Streptococcus, Western Australia, Australia, 2000–2018. Emerg Infect Dis 28:2190–2197. https://doi.org/10.3201/eid2811.220029. (PMID: 10.3201/eid2811.220029362858859622247)
Roujeau J-C, Sigurgeirsson B, Korting H-C, Kerl H, Paul C (2004) Chronic dermatomycoses of the foot as risk factors for Acute Bacterial Cellulitis of the Leg: a case-control study. Dermatology 209:301–307. https://doi.org/10.1159/000080853. (PMID: 10.1159/00008085315539893)
Laupland KB, Ross T, Church DL, Gregson DB (2006) Population-based surveillance of invasive pyogenic streptococcal infection in a large Canadian region. Clin Microbiol Infect 12:224–230. https://doi.org/10.1111/j.1469-0691.2005.01345.x. (PMID: 10.1111/j.1469-0691.2005.01345.x16451408)
Nevanlinna V, Huttunen R, Aittoniemi J, Luukkaala T, Rantala S Major risk factors for Streptococcus dysgalactiae subsp. equisimilis bacteremia: a population-based study. BMC Infect Dis 2023;23. https://doi.org/10.1186/s12879-023-07992-9.
Factor SH, Levine OS, Harrison LH, Farley MM, Mcgeer A, Skoff T et al (2005) Risk Factors for Pediatric Invasive Group A Streptococcal Disease.
Casqueiro J, Casqueiro J, Alves C (2012) Infections in patients with diabetes mellitus: a review of pathogenesis. Indian J Endocrinol Metab 16:27. https://doi.org/10.4103/2230-8210.94253. (PMID: 10.4103/2230-8210.94253)
Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J (2009) Predictors of mortality in beta-hemolytic streptococcal bacteremia: a population-based study. J Infect 58 4:266–272. (PMID: 10.1016/j.jinf.2009.01.015)
Kaspersen KA, Pedersen OB, Petersen MS, Hjalgrim H, Rostgaard K, Møller BK et al (2015) Obesity and risk of infection: results from the Danish blood Donor Study. Epidemiology ;26.
Lother SA, Jassal DS, Lagacé-Wiens P, Keynan Y (2017) Emerging group C and group G streptococcal endocarditis: a Canadian perspective. Int J Infect Dis 65:128–132. https://doi.org/10.1016/j.ijid.2017.10.018. (PMID: 10.1016/j.ijid.2017.10.01829097247)
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS et al (2009) Clinical presentation, etiology, and Outcome of Infective endocarditis in the 21st Century: the international collaboration on endocarditis–prospective cohort study. Arch Intern Med 169:463–473. https://doi.org/10.1001/archinternmed.2008.603. (PMID: 10.1001/archinternmed.2008.603192737763625651)
Loubinoux J, Plainvert C, Collobert G, Touak G, Bouvet A, Poyart C et al (2013) Adult invasive and noninvasive infections due to Streptococcus dysgalactiae subsp. equisimilis in France from 2006 to 2010. J Clin Microbiol 51:2724–2727. https://doi.org/10.1128/jcm.01262-13. (PMID: 10.1128/jcm.01262-13236985313719644)
Xie O, Tong SYC (2023) Heterogeneity in risk of newly classified typical Streptococci as causes of Infective Endocarditis. Clin Infect Dis 77:1219–1220. https://doi.org/10.1093/cid/ciad392. (PMID: 10.1093/cid/ciad39237382033)
Wald-Dickler N, Holtom PD, Phillips MC, Centor RM, Lee RA, Baden R et al (2022) Oral is the New IV. Challenging decades of blood and bone infection dogma: a systematic review. Am J Med 135:369–379e1. https://doi.org/10.1016/j.amjmed.2021.10.007. (PMID: 10.1016/j.amjmed.2021.10.00734715060)
Davar K, Clark D, Centor RM, Dominguez F, Ghanem B, Lee R et al (2023) Can the future of ID escape the Inertial Dogma of its past? The exemplars of shorter is better and oral is the New IV. Open Forum Infect Dis 10:ofac706. https://doi.org/10.1093/ofid/ofac706. (PMID: 10.1093/ofid/ofac70636694838)

Keywords: Streptococcus dysgalactiae subsp. equisimilis (SDSE); Epidemiology and clinical features; Group C and G Streptococcus (GCGS)

0 (Anti-Bacterial Agents)

Streptococcus dysgalactiae subsp. equisimilis

Date Created: 20240715 Date Completed: 20240827 Latest Revision: 20240827

20240828

10.1007/s10096-024-04903-x

39008148