Sharp increase in the incidence and severity of invasive Streptococcus pyogenes infections in children after the COVID-19 pandemic (2019-2023): A nationwide multicenter study
Elvira Cobo-Vázquez, David Aguilera‐Alonso, David Grandioso-Vas, Anna Gamell, Victoria Rello-Saltor, Manuel Oltra‐Benavent, Eloísa Cervantes, Francisco José Sanz-Santaeufemia, Jaime Carrasco-Colom, Ángela Manzanares-Casteleiro, Laura Martín-Pedraz, Eva Ramírez de Arellano, Lola Falcón-Neira, Leticia Martínez-Campos, Elena Colino-Gil, Beatriz Jiménez-Montero, Olga Calavia, Anna Hernandez-Ventura, Elena Del Castillo-Navío, Vanesa Matías-Del Pozo, Laura Calle-Miguel, Beatriz Soto, Berta Fernández, Filip Camil-Olteanu, Marta Pareja-León, N. López Segura, Fátima Ara-Montojo, Beatriz Ruiz-Sáez, Cristina Calvo-Monge, María Isabel Sánchez-Códez, Teresa Reinoso, Katie Badillo, Carmen Vázquez, Pilar Villalón, Jesús Oteo, Isabel Mellado-Sola, Emilia Cercenado, Daniel Blázquez‐Gamero, Ana Menasalvas, María José González-Abad, Borja Guarch, Mercedes Ibáñez-Alcalde, Begoña Carazo, Mayli Lung, Cristina Calvo, Jesús Saavedra‐Lozano
Abstract
Objectives A global surge in pediatric invasive group A streptococcal infection (iGAS) was reported after autumn 2022. This study analyzed the epidemiology and severity of iGAS in Spain, comparing two periods; P1: pre-outbreak (January 2019-September 2022) versus P2: outbreak (October 2022-July 2023). Methods Children ≤16 years with iGAS enrolled in the Spanish PedGAS-net (2019-2023), were included. Bacterial isolates were analyzed for emm typing, antibiotic susceptibility, and whole genome sequencing. Multivariate analysis identified risk factors for PICU admission and mortality. Results 558 cases were included; 307 (55.1%) were male, with a median age of 43.9 months (IQR:19.3-84.1). There were significantly more iGAS in P2 (35.7 vs. 4.5 cases/month, P < 0 . 001), with higher PICU admissions (51.3% vs. 30.8%, P < 0 . 001). Pneumonia was the most common syndrome (32.3%), with pleural effusion in 58.3%. Of the 130 samples available for emm -typing, the most frequent were emm 1 (56.1%) and emm 12 (27.1%). 245 (43.9%) required PICU admission. Factors associated with PICU were streptococcal toxic shock syndrome (STSS), pneumonia, necrotizing fasciitis, acute kidney failure, and previous consultation before diagnosis. The emm 1 (especially M1 UK ) increased PICU risk. 11 children (2.0%) died. STSS, sepsis, and central nervous system infection were associated with mortality. Conclusion In Spain, pediatric iGAS cases sharply increased during 2022-2023, with a remarkable increase in severity. Epidemiological surveillance of iGAS remains crucial.