Beta-Haemolytic Group A, C and G Streptococcal Infections in Southern Hungary: A 10-Year Population-Based Retrospective Survey (2008-2017) and a Review of the Literature

• Published in: Infection and drug resistance 2020-01, Vol.13, p.4739-4749
• Main Authors: Gajdacs, Mario, Abrok, Marianna, Lazar, Andrea, Burian, Katalin
• Format: Article
• Language: English
• Subjects: Abscesses; Antibiotics; Bacteria; Blood; Blood culture; Cardiovascular disease; Cerebrospinal fluid; Clindamycin; Data analysis; Data collection; Drug resistance in microorganisms; Epidemiology; Erythromycin; group a streptococcus; group c streptococcus; group g streptococcus; Health surveillance; hungary; Infection; Laboratories; Literature reviews; Medical examination; Medical research; Medicine, Experimental; Microbiology; Necrotizing fasciitis; Norfloxacin; Original Research; Penicillin; Pharyngitis; Pleural fluid; Population; Public health; Rheumatic fever; Scarlet fever; Streptococcal infections; streptococcus dysgalactiae subspecies equisimilis; Streptococcus infections; streptococcus pyogenes; Synovial fluid; Tetracycline; Tetracyclines
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S279157

Pyogenic β-hemolytic streptococci (including Group A, C and G ) are some of the most important Gram-positive bacterial pathogens in human medicine. Although effective therapy is available, invasive streptococcal infections are associated with a significant disease burden. In this retrospective study, the epidemiological characteristics of invasive Group A (iGAS) and Group C and G (iGCGS) streptococci, along with tonsillo-pharyngitis-causing pGAS and pGCGS infections, were assessed in Southern Hungary. A total of 1554 cases of streptococcal tonsillo-pharyngitis infections (26.5-44.1/100,000 persons, pGAS: 95.5%; n=1484) and 1104 cases of invasive streptococcal infections were detected (12.5-31.4/100,000 persons, iGAS: 77.9%; n=861). The average age of the affected patients in the various groups were the following: pGAS: 13.2±13.1 years, pGCGS: 21.0±15.0 years (p=0.039), iGAS: 49.1±12.8 years, iGCGS: 58.7±18.5 years (p>0.05). iGAS isolates originated from abscesses (47.1%), blood culture samples (24.1%), surgical samples (16.7%), biopsies (4.6%), pleural fluid (3.5%), pus (2.0%), synovial fluid (1.3%) and cerebrospinal fluid samples (0.7%). In contrast, iGCGS isolates mainly originated from blood culture samples (53.8%), abscesses (22.9%), surgical samples (12.3%), synovial fluid (5.1%), pleural fluid (3.7%), pus (1.8%) and cerebrospinal fluid samples (0.4%). All respective isolates were susceptible to benzyl-penicillin; overall resistance levels for erythromycin (10.5% for GAS, 21.4% for GCGS) and clindamycin (9.2% for GAS, 17.2% for GCGS) were significantly higher in GCGS isolates, while resistance levels for norfloxacin were higher in GAS isolates (13.5% for GAS, 6.9% for GCGS). The rates of resistance to macrolides and clindamycin are a cause for concern (especially among GCGS isolates); however, resistance levels are still relatively low, compared to Southern European countries.