Article Dans Une Revue Critical Care Année : 2024

Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study)

1 CHU de Bordeaux Pellegrin [Bordeaux]
2 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
3 Hôpital Saint-André [Bordeaux]
4 Hôpital Pellegrin
5 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
6 MIP - Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance
7 Centre Hospitalier d'Annecy Genevois
8 CHBA - Centre Hospitalier Bretagne Atlantique (Vannes-Auray)
9 Hôpital de Saint-Brieuc [Hôpital Yves Le Foll]
10 Centre Hospitalier Boulogne-sur-mer
11 Centre Hospitalier Le Mans (CH Le Mans)
12 CHAC - Centre Hospitalier Alès-Cévennes
13 CHP - CENTRE HOSPITALIER PÉRIGUEUX
14 Groupe Hospitalier du Havre
15 GHBS - Groupe Hospitalier Bretagne Sud
16 Centre hospitalier de Pau
17 CHAL - Centre Hospitalier Alpes Léman
18 CEPR - U 1100 - Centre d’Etude des Pathologies Respiratoires [Tours]
19 HAL – CH Dunkerque - Hôpital Alexandra Lepève – Centre Hospitalier de Dunkerque
20 CH la Rochelle - Centre Hospitalier de la Rochelle - Ré Aunis- Hôpital Saint Louis
21 Centre Hospitalier Libourne
22 Centre Hospitalier Intercommunal de Toulon [La Seyne-sur-Mer]
23 Centre Hospitalier Sud Essonnes Dourdan Etampes
24 Groupe hospitalier de la région de Mulhouse et Sud-Alsace
25 CHRO - Centre Hospitalier Régional d'Orléans
26 Centre hospitalier de Saintes
27 CHU Caen Normandie - CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie
28 Groupe Hospitalier Nord Essonne [Longjumeau]
29 Centre Hospitalier de Lens
30 CH Angoulême - Centre Hospitalier d'Angoulême
31 CH Cholet - Centre Hospitalier de Cholet
32 CH Dax - Centre Hospitalier Dax - Côte d'Argent
33 Centre hospitalier de Dieppe
34 Centre Hospitalier de Roanne
35 CH Saint-Lô - Centre Hospitalier Mémorial France États-Unis de Saint-Lô
36 Centre Hospitalier de Haguenau
37 CHIMM - Centre Hospitalier intercommunal de Meulan les Mureaux
38 Centre hospitalier de Saint-Nazaire
39 DIOPP - Département interdisciplinaire d’organisation des parcours patients
40 MFP - Microbiologie Fondamentale et Pathogénicité
41 Hôpital Haut-Lévêque [CHU Bordeaux]
42 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
Arthur Orieux

Résumé

Background Group A Streptococcus is responsible for severe and potentially lethal invasive conditions requiring intensive care unit (ICU) admission, such as streptococcal toxic shock-like syndrome (STSS). A rebound of invasive group A streptococcal (iGAS) infection after COVID-19-associated barrier measures has been observed in children. Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. We aimed to compare the incidence of iGAS infection before and after the COVID-19 pandemic, describe iGAS patients’ characteristics, and determine ICU mortality associated factors. Methods We performed a retrospective multicenter cohort study in 37 French ICUs, including all patients admitted for iGAS infections for two periods: two years before period (October 2018 to March 2019 and October 2019 to March 2020) and a one-year after period (October 2022 to March 2023) COVID-19 pandemic. iGAS infection was defined by Group A Streptococcus isolation from a normally sterile site. iGAS infections were identified using the International Classification of Diseases and confirmed with each center's microbiology laboratory databases. The incidence of iGAS infections was expressed in case rate. Results Two hundred and twenty-two patients were admitted to ICU for iGAS infections: 73 before and 149 after COVID-19 pandemic. Their case rate during the period before and after COVID-19 pandemic was 205 and 949/100,000 ICU admissions, respectively ( p < 0.001), with more frequent STSS after the COVID-19 pandemic (61% vs. 45%, p = 0.015). iGAS patients ( n = 222) had a median SOFA score of 8 (5–13), invasive mechanical ventilation and norepinephrine in 61% and 74% of patients. ICU mortality in iGAS patients was 19% (14% before and 22% after COVID-19 pandemic; p = 0.135). In multivariate analysis, invasive mechanical ventilation (OR = 6.08 (1.71–21.60), p = 0.005), STSS (OR = 5.75 (1.71–19.22), p = 0.005), acute kidney injury (OR = 4.85 (1.05–22.42), p = 0.043), immunosuppression (OR = 4.02 (1.03–15.59), p = 0.044), and diabetes (OR = 3.92 (1.42–10.79), p = 0.008) were significantly associated with ICU mortality. Conclusion The incidence of iGAS infections requiring ICU admission increased by 4 to 5 after the COVID-19 pandemic. After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.

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hal-05500307 , version 1 (13-03-2026)

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Arthur Orieux, Renaud Prevel, Margot Dumery, Jean-Baptiste Lascarrou, Noémie Zucman, et al.. Invasive group A streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study). Critical Care, 2024, 28 (1), pp.4. ⟨10.1186/s13054-023-04774-2⟩. ⟨hal-05500307⟩
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