Invasive group A streptococcal (GAS) infections causes significant morbidity and mortality. A national survey was initiated to assess the burden of invasive GAS infections in France, describe their clinical characteristics, and assess the molecular characteristics of GAS strains responsible for these infections. The survey was conducted in 194 hospitals, accounting for 51% of acute care hospital admissions in France. Clinical, predisposing factors and demographic data were obtained and all GAS isolates were emm sequence-typed. We identified 664 cases of invasive GAS infections with an annual incidence of 3.1 per 100,000 population. The case-fatality ratio was 14%, and rose to 43% in case of streptococcal toxic shock syndrome. Bacteremia without identified focus (22%) and skin/soft tissue infections (30%) were the most frequent clinical presentations. Necrotizing fasciitis was frequent in adults (18%) and uncommon in children (3%). The 3 predominant emm types were emm1, emm89 and emm28 accounting for 33%, 16%, and 10% of GAS isolates, respectively. emm1 type was associated with fatal outcome and was more frequent in children than in adults. Six clusters of cases were identified, each cluster involving 2 invasive cases due to GAS strains which shared identical GAS emm sequence-types. Four clusters of cases involved 8 postpartum infections, one family cluster involved mother and child, and one cluster involved two patients in a nursing home. Invasive GAS infection is one of the most severe bacterial diseases in France, particularly in persons aged e 50 years or when associated with toxic shock syndrome. (R.A.)
Auteur : Lepoutre A, Doloy A, Bidet P, Leblond A, Perrocheau A, Bingen E, Trieu Cuot P, Bouvet A, Poyart C, Levy Bruhl D
Journal of Clinical Microbiology, 2011, vol. 49, n°. 12, p. 4094-4100
