Streptokinase reduces Streptococcus dysgalactiae subsp. equisimilis biofilm formation.

Background: Streptococcus dysgalactiae subspecies equisimilis (SDSE) is increasingly recognized as an emerging cause of invasive diseases including necrotizing soft tissue infections (NSTIs). In contrast to the closely related Streptococcus pyogenes, SDSE infections mainly affect older and comorbid patients. Biofilm formation has been demonstrated in soft tissue biopsies of S.

Antimicrobial resistance patterns in in a One Health perspective.

Background: (SD) is an important pathogen in humans as well as in a broad range of animal species. Escalating rates of antibiotic resistance in SD has been reported in both human and veterinary clinical practice, but the dissemination of resistance determinants has so far never been examined in a One Health Perspective. We wanted to explore the occurrence of zoonotic transmission of SD and the potential for exchange of resistance traits between SD from different host populations.

Obstetric infections and clinical characteristics of maternal sepsis: a hospital-based retrospective cohort study.

Sepsis is responsible for 50% of intrahospital maternal deaths worldwide. Incidence is increasing in both low and middle-, and high-income countries. There is little data on incidence and clinical outcomes of obstetric infections including maternal sepsis in the Nordic countries.

Necrotising soft tissue infections.

Necrotising soft tissue infections can affect the skin, subcutaneous tissue, superficial fascia, deep fascia and musculature. The infections are severe, they spread quickly and can result in extensive tissue loss. Although rare, morbidity and mortality rates are high.

Genomic epidemiology of subsp. strains causing invasive disease in Norway during 2018.

Background: subspecies (SDSE) is an emerging global pathogen, yet the epidemiology and population genetics of SDSE species have not been extensively characterized.

Methods: We carried out whole genome sequencing to characterize 274 SDSE isolates causing bloodstream infections obtained through national surveillance program in 2018. We conducted multilocus sequence typing (MLST), -typing, core genome phylogeny, as well as investigated key features associated with virulence.

Neutrophil-derived reactive agents induce a transient SpeB negative phenotype in Streptococcus pyogenes.

Background: Streptococcus pyogenes (group A streptococci; GAS) is the main causative pathogen of monomicrobial necrotizing soft tissue infections (NSTIs). To resist immuno-clearance, GAS adapt their genetic information and/or phenotype to the surrounding environment. Hyper-virulent streptococcal pyrogenic exotoxin B (SpeB) negative variants caused by covRS mutations are enriched during infection.

Systemic immune activation profiles in streptococcal necrotizing soft tissue infections: A prospective multicenter study.

Objective: Early stages with streptococcal necrotizing soft tissue infections (NSTIs) are often difficult to discern from cellulitis. Increased insight into inflammatory responses in streptococcal disease may guide correct interventions and discovery of novel diagnostic targets.

Methods: Plasma levels of 37 mediators, leucocytes and CRP from 102 patients with β-hemolytic streptococcal NSTI derived from a prospective Scandinavian multicentre study were compared to those of 23 cases of streptococcal cellulitis.

Scoring systems for early detection of sepsis on the ward.

Background: Sepsis is one of the most common causes of death in Norwegian hospitals. The condition is often overlooked with treatment being delayed. Scoring systems to detect patients with sepsis have mostly been studied in emergency departments and more rarely on wards.

Streptococcus dysgalactiae Bloodstream Infections, Norway, 1999-2021.

Streptococcus dysgalactiae increasingly is recognized as a pathogen of concern for human health. However, longitudinal surveillance data describing temporal trends of S. dysgalactiae are scarce.

Clinical Characteristics and Histopathology in Suspected Necrotizing Soft Tissue Infections.

Background: Necrotizing soft tissue infections (NSTIs) are severe diseases with high morbidity and mortality. The diagnosis is challenging. Several guidelines recommend tissue biopsies as an adjunct diagnostic in routine management, but neither biopsy sampling nor classification is standardized or validated.

Decision support system and outcome prediction in a cohort of patients with necrotizing soft-tissue infections.

Introduction: Necrotizing Soft Tissue Infections (NSTI) are severe infections with high mortality affecting a heterogeneous patient population. There is a need for a clinical decision support system which predicts outcomes and provides treatment recommendations early in the disease course.

Methods: To identify relevant clinical needs, interviews with eight medical professionals (surgeons, intensivists, general practitioner, emergency department physician) were conducted.

Consistent Biofilm Formation by Isolated From Patients With Necrotizing Soft Tissue Infections.

Objectives: Biofilm formation has been demonstrated in muscle and soft tissue samples from patients with necrotizing soft tissue infection (NSTI) caused by , but the clinical importance of this observation is not clear. Although M-protein has been shown to be important for biofilm formation in , the evidence for an association between type and biofilm forming capacity is conflicting. Here we characterize the biofilm forming capacity in a collection of isolates causing NSTI, and relate this to type of the isolates and clinical characteristics of the patients.

Discriminatory plasma biomarkers predict specific clinical phenotypes of necrotizing soft-tissue infections.

BACKGROUNDNecrotizing soft-tissue infections (NSTIs) are rapidly progressing infections frequently complicated by septic shock and associated with high mortality. Early diagnosis is critical for patient outcome, but challenging due to vague initial symptoms. Here, we identified predictive biomarkers for NSTI clinical phenotypes and outcomes using a prospective multicenter NSTI patient cohort.

Systems and Precision Medicine in Necrotizing Soft Tissue Infections.

Necrotizing soft tissue infections (NSTI) are multifactorial and characterized by dysfunctional, time dependent, highly varying hyper- to hypo-inflammatory host responses contributing to disease severity. Furthermore, host-pathogen interactions are diverse and difficult to identify and characterize, due to the many different disease endotypes. There is a need for both refined bedside diagnostics as well as novel targeted treatment options to improve outcome in NSTI.

Beta-Hemolytic Streptococci and Necrotizing Soft Tissue Infections.

β-hemolytic streptococci are major causes of necrotizing soft tissue infections (NSTIs), Streptococcus pyogenes (group A streptococcus; GAS) in particular. NSTIs caused by Streptococcus dysgalactiae (SD) have also been reported. In the INFECT cohort of 409 NSTIs patients, more than a third of the cases were caused by GAS (31%) or SD (7%).

Microbiological Etiology of Necrotizing Soft Tissue Infections.

Necrotizing soft tissue infections (NSTIs) are severe clinical conditions requiring swift therapeutic intervention, including surgical removal of infected tissue and administration of potent antibiotics. There is wide diversity in the microbial etiologic agents, and tailoring the antibiotic treatment to the offending pathogen is essential. However, the choice of empirical therapy is frequently inadequate, underlining the need for comprehensive and contemporary knowledge on causative pathogens and relevant antimicrobial resistance patterns in NSTIs.

Necrotizing Soft Tissue Infections: Case Reports, from the Clinician's Perspectives.

Necrotizing soft tissue infections (NSTI) are rapidly spreading and life-threatening infections of skin and soft tissue. Essentially there are two types of NSTI, based on the invasive microorganisms. The speed of development and associated clinical features differ markedly depending on the bacterial etiology.

Emerging Threat of Antimicrobial Resistance in β-Hemolytic Streptococci.

Highly variable resistance rates to erythromycin and clindamycin have been reported in the β-hemolytic streptococcal species , , and , depending on geographic and temporal context. In the present study we aimed to examine the longitudinal trends of antimicrobial resistance in these three species in a northern European setting. Furthermore, we used whole genome sequencing to identify resistance determinants and the mobile genetic elements involved in their dissemination, as well as elucidate phylogenetic relationships.

Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort.

Skin and soft tissue infections (SSTIs) are increasing. Frequent over- and under-treatment has been reported, including non-purulent SSTIs where cases demanding surgery or broad-spectrum therapy often are hard to identify. Our aim was to measure the predictive power of a modified severity score and use it to identify areas of improvement in antimicrobial therapy of non-purulent SSTIs.

Risk Factors and Predictors of Mortality in Streptococcal Necrotizing Soft-tissue Infections: A Multicenter Prospective Study.

Background: 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.

Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections.

Analyses of plasma collected pre- and postadministration of intravenous immunoglobulin (IVIG) from patients with group A Streptococcus necrotizing soft tissue infections demonstrated a negative correlation between IVIG dose and toxin-triggered T-cell proliferation (r = -.67, P < .0001).