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. 2024 Aug 27;11(9):ofae486.
doi: 10.1093/ofid/ofae486. eCollection 2024 Sep.

Characteristics of Streptococcal Toxic Shock Syndrome Caused by Different Beta-hemolytic Streptococci Species: A Single-center Retrospective Study

Makoto Inada  1 , Noriko Iwamoto  1   2 , Hidetoshi Nomoto  1 , Shinya Tsuzuki  1   2 , Norihiko Takemoto  3 , Noriko Fuwa  1 , Ataru Moriya  4 , Norio Ohmagari  1   2
Affiliations

Characteristics of Streptococcal Toxic Shock Syndrome Caused by Different Beta-hemolytic Streptococci Species: A Single-center Retrospective Study

Makoto Inada et al. Open Forum Infect Dis. .

Abstract

Background: Streptococcal toxic shock syndrome (STSS) is a life-threatening condition caused by beta-hemolytic streptococci (BHS). Streptococcus pyogenes is the main causative agent of this disease; other BHS such as Streptococcus agalactiae or Streptococcus dysgalactiae could also cause STSS. However, the clinical characteristics of STSS caused by other types of BHS remain poorly understood. In this study, we evaluated the likelihood of STSS development in various streptococcal species.

Methods: We conducted a retrospective observational study using adult medical records of patients with invasive BHS in a tertiary care institution from 2002 to 2022 and classified them into STSS or non-STSS groups. Multivariable analysis of bacterial species adjusted for age and diabetes mellitus was conducted. S pyogenes cases were propensity-matched (1:4) to non-pyogenes BHS cases.

Results: A total of 43 STSS and 285 non-STSS cases were identified. S pyogenes, S agalactiae, and S dysgalactiae accounted for 17, 13, and 13 STSS cases, respectively. The crude mortality of STSS was approximately 35% in all groups. A multivariable analysis suggested that STSS was less frequent in S agalactiae and S dysgalactiae cases with odds ratio 0.24 (95% confidence interval [CI], 0.10-0.54; P < .001) and 0.23 (95% CI, .10-.55; P < .001), respectively. Propensity score matching showed that S pyogenes caused STSS more frequently than other BHS cases with an odds ratio of 3.28 (95% CI 1.21-8.77; P = .010).

Conclusions: This study described and compared the clinical characteristics of STSS caused by different BHS. We demonstrated that S pyogenes caused STSS more often than other BHS.

Keywords: beta-hemolytic streptococci; streptococcal toxic shock syndrome; streptococcus agalactiae; streptococcus dysgalactiae; streptococcus pyogenes.

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Conflict of interest statement

Potential Conflicts of Interest. The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Balance of covariates before and after propensity score matching. Red triangles represent absolute standardized mean differences (SMDs) before adjustment and blue circles represent SMDs after adjustment. BMI, body mass index; DM, diabetes mellitus; LC, liver cirrhosis; sex, male; skin, skin diseases.
See this image and copyright information in PMC

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