Critical Care volume 28 , Article number: 4 Cite this article. Metrics details. 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.
Several intensivists of French adult ICUs have reported similar bedside impressions without objective data. The incidence of iGAS infections was expressed in case rate. Streptococcus pyogenes, also called group A Streptococcus GAS , is a Gram-positive bacterium responsible for human diseases ranging from pauci-symptomatic superficial infections pharyngitis, impetigo to severe and potentially lethal, invasive conditions necrotizing fasciitis or streptococcal toxic shock-like syndrome [STSS] named invasive group A streptococcal iGAS infections [ 1 ].
The risk factors for iGAS infection are numerous. Diabetes, cardiac disease, and acute kidney injury AKI are associated with an increased risk of invasive GAS disease [ 3 , 4 , 5 ]. Also, children, the immunocompromised HIV infection, malignancy , and older patients are at the most significant risk of iGAS infections. Moreover, the management of iGAS infections is debated. Early surgical source control debridement of necrotic tissue, surgical drainage is a vital management part [ 6 ].
The use of adjunctive clindamycin may improve outcomes because of its antitoxin effects and excellent tissue penetration, even in patients without STSS or necrotizing fasciitis [ 7 ]. At present, there is a lack of data about intravenous immunoglobulin IVIG use and consensus about linezolid for the treatment of iGAS infection [ 8 , 9 ]. Still, most reported cases, whether they are associated with STSS or not, are superinfections of viral influenza or respiratory syncytial virus [RSV] respiratory infections, as previously reported [ 12 , 13 ].
It seems to result from a rebound after barrier measures in children whose immune system has not been in contact with commonly circulating GAS strains [ 14 ]. After the COVID pandemic, a Danish study [ 15 ] reported an abnormally high incidence of GAS meningitis in adults 11 cases along with another study describing 4 cases of severe iGAS infections, some of which in adults, in Nederland [ 16 ]. Nevertheless, to date, no objective data support this bedside impression.
