Pyogenic study: Effect of the COVID-19 pandemic on the incidence, clinical presentation and outcome of Streptococcus pyogenes infection requiring intensive care admission.

内容摘要

To describe invasive S. pyogenes infections (iGAS) requiring Intensive Care Unit (ICU) admission in Spain and to compare their epidemiological, clinical, microbiological, and outcome characteristics before and after the COVID-19 pandemic. A multicenter retrospective observational study was carried out. A total of 21 Spanish ICUs. Adult patients admitted to the ICU with confirmed iGAS infection between 2018 and 2023. Clinical, epidemiological, and microbiological data were analyzed. Annual incidence of iGAS, source of infection, clinical severity, need for advanced respiratory support, ICU length of stay, mortality, and antimicrobial susceptibility patterns. A total of 195 patients were included (59% male, median age 55 years). Skin and soft tissue infections were the most frequent source (53%), followed by pneumonia (39%). The annual incidence of iGAS declined at the beginning of the pandemic, reached its lowest level in 2021, and subsequently increased in 2022-2023, with an approximately two-fold higher incidence (RR&#x2009;=&#x2009;1.96; 95%CI: 1.47-2.62). This increase was primarily driven by pneumonia, which accounted for 44.5% of the post-pandemic cases compared to 28.4% in the pre-pandemic period (p&#x2009;<&#x2009;0.001). Post-pandemic patients exhibited higher rates of ARDS, greater need for prolonged mechanical ventilation and ECMO, and longer ICU stays, while mortality remained stable (approximately 20%). Following the COVID-19 pandemic, ICU admissions due to iGAS infections in Spain increased significantly, largely due to increased respiratory involvement. These findings underscore significant changes in S. pyogenes epidemiology and stress the importance of continuous surveillance following viral pandemics.