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dc.contributor.authorBruun, Trond
dc.contributor.authorRath, Eivind
dc.contributor.authorBruun Madsen, Martin
dc.contributor.authorOppegaard, Oddvar
dc.contributor.authorNekludov, Michael
dc.contributor.authorArnell, Per
dc.contributor.authorKarlsson, Ylva
dc.contributor.authorBabbar, Anshu
dc.contributor.authorBergey, Francois
dc.contributor.authorItzek, Andreas
dc.contributor.authorHyldegaard, Ole
dc.contributor.authorNorrby-Teglund, Anna
dc.contributor.authorSkrede, Steinar
dc.contributor.authorINFECT Study Group
dc.identifier.citationClin Infect Dis. 2020 Jan 10. pii: 5700429. doi: 10.1093/cid/ciaa027.en_US
dc.description.abstractBackground Necrotizing soft-tissue infections (NSTI) are life-threatening conditions often caused by β-hemolytic streptococci, group A streptococcus (GAS) in particular. Optimal treatment is contentious. The INFECT cohort includes the largest set of prospectively enrolled streptococcal NSTI cases to date. Methods From the INFECT cohort of 409 adults admitted with NSTI to five clinical centers in Scandinavia, patients culture-positive for GAS or Streptococcus dysgalactiae (SD) were selected. Risk factors were identified by comparison with a cohort of non-necrotizing streptococcal cellulitis. The impact of baseline factors and treatment on 90-day mortality was explored using Lasso regression. Whole-genome sequencing of bacterial isolates was used for emm typing and virulence gene profiling. Results The 126 GAS NSTI cases and 27 cases caused by SD constituted 31% and 7% of the whole NSTI cohort, respectively. When comparing to non-necrotizing streptococcal cellulitis, streptococcal NSTI was associated to blunt trauma, absence of pre-existing skin lesions, and a lower BMI. Septic shock was significantly more frequent in GAS (65%) compared to SD (41%) and polymicrobial, non-streptococcal NSTI (46%). Age, male sex, septic shock, and no administration of intravenous immunoglobulin (IVIG) were among factors associated with 90-day mortality. Predominant emm types were emm1, emm3 and emm28 in GAS and stG62647 in SD.en_US
dc.publisherOxford University Press (OUP)en_US
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 International*
dc.subjectGroup A streptococcusen_US
dc.subjectIntravenous immunoglobulin Gen_US
dc.subjectNecrotizing fasciitisen_US
dc.subjectStreptococcus dysgalactiaeen_US
dc.subjectStreptococcus pyogenesen_US
dc.titleRisk factors and Predictors of Mortality in Streptococcal Necrotizing Soft-Tissue Infections: A Multicenter Prospective Study.en_US
dc.contributor.departmentHZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany.en_US
dc.identifier.journalClinical Infectious Diseases en_US
dc.source.journaltitleClinical infectious diseases : an official publication of the Infectious Diseases Society of America

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