Centre National de Référence des Streptocoques (CNR-Strep), Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris, France.
Clin Microbiol Infect. 2012 Jul;18(7):702-10. doi: 10.1111/j.1469-0691.2011.03624.x. Epub 2011 Aug 29.
Severe invasive group A streptococcal diseases have re-emerged during the past 10-20 years. In order to provide a better insight into the current epidemiological situation in France, we analysed the questionnaires regarding all invasive strains received at the National Reference Center for Streptococci (CNR-Strep) between 2006 and 2010 from patients aged ≥ 18 and characterized them by emm typing, spe gene detection and antibiotic resistance. Among the 1542 invasive GAS strains studied, 78% (n=1206) were from blood cultures, and a streptococcal toxic shock syndrome (STSS) was described in 22% (n=340) of cases, mainly associated with necrotizing fasciitis (NF) and pleuro-pulmonary infections (p<0.001). The in-hospital fatality rate was 15%. A total of 83 different emm types were recovered but the three predominant emm types, representing almost 60% of the isolates, were emm1 (24%), emm28 (17%) and emm89 (15%). The preponderance of each emm type varied according to the year, with a significant constant increase of emm28 strains, whereas emm1 strains, representing approximately 32% of GAS invasive isolates in 2007 and 2008, dropped to <15% in 2010 (p<0.001). The distribution of phage-associated superantigen genes (speA, speC and ssa) was linked to certain emm types. Between 2006 and 2010, the percentage that was macrolide-resistant decreased from 11% to 5%, confirming the trend observed in 2007. Fortunately, emm1 strains associated with the most life-threatening clinical manifestations remain susceptible to all anti-streptococcal antibiotics.
严重侵袭性 A 组链球菌病在过去 10-20 年重新出现。为了更好地了解法国目前的流行病学情况，我们分析了 2006 年至 2010 年期间国家链球菌参考中心（CNR-Strep）收到的所有≥18 岁侵袭性菌株的问卷，并通过emm 分型、spe 基因检测和抗生素耐药性对其进行了特征描述。在研究的 1542 株侵袭性 GAS 菌株中，78%（n=1206）来自血培养，22%（n=340）的病例描述了链球菌中毒性休克综合征（STSS），主要与坏死性筋膜炎（NF）和胸膜-肺部感染有关（p<0.001）。住院病死率为 15%。共回收了 83 种不同的 emm 型，但三种主要的 emm 型，代表了近 60%的分离株，分别是 emm1（24%）、emm28（17%）和 emm89（15%）。每种 emm 型的优势因年份而异，emm28 菌株显著增加，而 emm1 菌株在 2007 年和 2008 年代表了约 32%的侵袭性 GAS 分离株，在 2010 年降至<15%（p<0.001）。噬菌体相关超抗原基因（speA、speC 和 ssa）的分布与某些 emm 型相关。2006 年至 2010 年，大环内酯类耐药率从 11%降至 5%，证实了 2007 年观察到的趋势。幸运的是，与最具威胁生命的临床表现相关的 emm1 菌株仍对所有抗链球菌抗生素敏感。
