Epidemiology of invasive Streptococcus pyogenes infections in Germany

Abstract number: 1733_254

Wahl R., Lütticken R., Stanzel S., van der Linden M., Reinert R.

Objectives: This study sought to identify epidemiological markers of invasive S. pyogenes disease in Germany.

Methods: A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany from 1996 until 2002. Demographic and clinical information on the invasive cases were obtained from medical files. 464 isolates from 475 patients were available for emm typing and characterisation of pathogenicity factors. Isolates were identified by their haemolysis on sheep blood agar, Lancefield grouping, using a commercially available agglutination technique and standard biochemical procedures. The presence of emm genes was determined by PCR using 'all M' primers following a previously published protocol. The presence of the genes speA, speC, speF, or ssa was determined by PCR. Multiple logistic regression analysis was performed to determine risk factors for fatal outcome.

Results: Invasive isolates were obtained from 475 patients, with 251 (52.8%) isolates cultured from blood. The most frequent emm types were emm 1 (36.4%), emm 28 (8.8%) and emm 3 (8%). The genes speA and speC and ssa were present at variable frequencies in different emm types. The highest rate of speA and speC were found in emm 1 (93.6%) and emm 4 (94.7%), respectively. The number of the annual estimated incidence of invasive GAS disease was at least 0.1 cases per 100,000 persons. Complete clinical information was available in 165 cases. The overall case fatality rate was 40.6% and highest in the age group 60–69 years (65.2%). Shock, age ≥30 years and adult respiratory distress syndrome (ARDS) were predictors of fatal outcome in a multiple logistic regression analysis. 6.7% of the cases were categorised as having been nosocomially acquired. Nine cases of puerperal sepsis were observed.

Conclusions: The study underscores the importance of invasive S. pyogenes disease in Germany. Chemoprophylaxis of selected contacts of patients with invasive infection, infection control, and prompt investigation of outbreaks in hospitals and nursing homes are possible measures to reduce the high burden of S. pyogenes disease.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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