Invasive disease due to B-hemolytic Streptococcus. Epidemiology and mortality

Abstract

Background: B-hemolytic streptococci(EBH) are responsible for diseases such as necrotizing fasciitis, toxic shock syndrome(SSTE) and post-infectious complications. EBHGA can present fulminant manifestations, as well as subtypes of EBHGC and EBHGG, which express homologous proteins. Objective: To characterize invasive disease due to EBH(EI) in adults, incidence, risk factors, presentation, subtypes, sensitivity and mortality in a period of 5.5 years in a Private Hospital Methods & Materials: Clinical, observational, descriptive and analytical study, transversal design. Retrospective review of positive EBH cultures during the period 01/01/2012-30/06/2017. Inpatients and outpatients older than 18 years were included. EIE was defined for the isolation of EBHGA, B, C, G and F in sterile place(blood, CSF, joint fluid, pleural, ascitic and collection) Blood cultures were performed in BACT/ALERT, cultured on sheep blood agar and latex particle agglutination typing. Sensitivity:disc diffusion and CIM using test strips(Etest) Data analysis:EPI Info7, P2α < 0.05 statistically significant. Results: 141 patients:male 51.7%, median age 72 years, 92.2% of cases in hospitalized patients. Total Mortality was 21.3%(30/141), 83.3% of the deceased(25/30) had comorbidities, with Age >65 years being a statistically significant variable with an impact on mortality, both in the bivariate and multivariate analysis. The absence of clinical focus showed a statistically significant higher mortality with high RR(2.84). The 81.25%(13/16) of bacteremia without focus ocurred in >65 years old, with a mortality of 75%(6/8). The SBHGB was responsible for 50%(8/16). The SBHGB was the most frequent agent(39.72%), with a mortality of 19.6%(11/56). The incidence in >65 years was 60.7% with a mortality of 90.9%(10/11). The clinical foci:deep abscess(29/141) and meningitis (6/141) had an impact on mortality, a statistically significant result in the multivariate analysis for meningeal focus and SSTE(30/141) p < 0.001 RR:6.39 Sensitivity to penicillin 100%, to clindamycin 80.5% of the strains tested. Conclusion: The EIE continues to be a prevalent disease, with a great impact on the elderly population and a high rate of lethality in the presence of risk factors. Greater mortality is highlighted in the absence of clinical focus and with SBHGB compared to other publications. The SSTE was caused equally by SBHGA and B.