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Multicenter Study
. 2024 Jan 2;28(1):4.
doi: 10.1186/s13054-023-04774-2.

Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study)

Arthur Orieux  1 , Renaud Prevel  2   3 , Margot Dumery  2 , Jean-Baptiste Lascarrou  4 , Noémie Zucman  5 , Florian Reizine  6 , Pierre Fillatre  7 , Charles Detollenaere  8 , Cédric Darreau  9 , Nadiejda Antier  10 , Mélanie Saint-Léger  11 , Guillaume Schnell  12 , Béatrice La Combe  13 , Charlotte Guesdon  14 , Franklin Bruna  15 , Antoine Guillon  16 , Caroline Varillon  17 , Olivier Lesieur  18 , Hubert Grand  19 , Benjamin Bertrand  20 , Shidasp Siami  21 , Pierre Oudeville  22 , Céline Besnard  23 , Romain Persichini  24 , Pierrick Bauduin  25 , Martial Thyrault  26 , Mathieu Evrard  27 , David Schnell  28 , Johann Auchabie  29 , Adrien Auvet  30 , Jean-Philippe Rigaud  31 , Pascal Beuret  32 , Maxime Leclerc  33 , Asaël Berger  34 , Omar Ben Hadj Salem  35 , Julien Lorber  36 , Annabelle Stoclin  37 , Olivier Guisset  2 , Léa Bientz  38 , Pierre Khan  39 , Vivien Guillotin  2 , Jean-Claude Lacherade  40 , Alexandre Boyer  2   3 ; ISTRE Group; Arthur Orieux, Renaud Prevel, Margot Dumery, Jean-Baptiste Lascarrou, 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, Omar Ben Hadj Salem, Julien Lorber, Annabelle Stoclin, Olivier Guisset, Léa Bientz, Pierre Khan, Vivien Guillotin, Jean-Claude Lacherade, Alexandre Boyer
Affiliations
Multicenter Study

Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study)

Arthur Orieux et al. Crit Care. .

Abstract

Background: Group 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.

Methods: We 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.

Results: Two 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.

Conclusion: The 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.

Keywords: ICU mortality; Invasive group A streptococcal infection; Streptococcal toxic shock syndrome intensive care unit.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
iGAS infections case rate in metropolitan’s ICUs before and after COVID-19. Case rate > 1000: red, Case rate 500–1000: orange, Case rate < 500: green. A Before COVID-19 (October 2018 to March 2019 and October 2019 to March 2020). B After COVID-19 (October 2022 to March 2023)
Fig. 2
Fig. 2
Comparison of survival rates according to time from iGAS infection with and without streptococcal toxic shock syndrome (STSS)
See this image and copyright information in PMC

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