Catastrophic Streptococcus pyogenes Disease: A Personalized Approach Based on Phenotypes and Treatable Traits

• Published in: Antibiotics (Basel) Vol. 13; no. 2; p. 187
• Main Authors: Ruiz-Rodríguez, Juan Carlos, Chiscano-Camón, Luis, Maldonado, Carolina, Ruiz-Sanmartin, Adolf, Martin, Laura, Bajaña, Ivan, Bastidas, Juliana, Lopez-Martinez, Rocio, Franco-Jarava, Clara, González-López, Juan José, Ribas, Vicent, Larrosa, Nieves, Riera, Jordi, Nuvials-Casals, Xavier, Ferrer, Ricard
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.02.2024
• Subjects: Antibiotics; Bacteria; Biomarkers; Cardiomyopathy; Catastrophic failure analysis; Customization; Cytokines; Disease; Emergency medical services; Extracorporeal membrane oxygenation; Genotype & phenotype; Health services; hemoadsorption; Immune system; Immunoglobulins; Infections; Mechanical ventilation; Medical prognosis; Morbidity; Mortality; multiorgan dysfunction; Oxygenation; Pathogens; Pathophysiology; Patients; Penicillin; Phenotypes; Pneumonia; Precision medicine; Proteins; S. pyogenes; Sepsis; Septic shock; severe sepsis; Soft tissues; Streptococcal toxic shock syndrome; Streptococcus infections; Streptococcus pyogenes; Thorax; United States > US; septic shock; streptococcal toxic shock syndrome; severe sepsis; sepsis phenotypes; precision medicine; hemoadsorption; S. pyogenes; multiorgan dysfunction
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics13020187

Streptococcal toxic shock syndrome (STTS) is a critical medical emergency marked by high morbidity and mortality, necessitating swift awareness, targeted treatment, and early source control due to its rapid symptom manifestation. This report focuses on a cohort of 13 patients admitted to Vall d'Hebron University Hospital Intensive Care Unit, Barcelona, from November 2022 to March 2023, exhibiting invasive infections and meeting institutional sepsis code activation criteria. The primary infections were community-acquired pneumonia (61.5%) and skin/soft tissue infection (30.8%). All patients received prompt antibiotic treatment, with clinical source control through thoracic drainage (30.8%) or surgical means (23.1%). Organ support involved invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy as per guidelines. Of note, 76.9% of patients experienced septic cardiomyopathy, and 53.8% required extracorporeal membrane oxygenation (ECMO). The study identified three distinct phenotypic profiles-hyperinflammatory, low perfusion, and hypogammaglobulinemic-which could guide personalized therapeutic approaches. STTS, with a mean SOFA score of 17 (5.7) and a 53.8% requiring ECMO, underscores the need for precision medicine-based rescue therapies and sepsis phenotype identification. Integrating these strategies with prompt antibiotics and efficient source control offers a potential avenue to mitigate organ failure, enhancing patient survival and recovery in the face of this severe clinical condition.