Volume 29, Number 3—March 2023
CME ACTIVITY - Research
Clonal Expansion of Multidrug-Resistant Streptococcus dysgalactiae Subspecies equisimilis Causing Bacteremia, Japan, 2005–2021
Table 2
Clinical manifestations and severity markers for 146 episodes of multidrug-resistant Streptococcus dysgalactiae subspecies equisimilis bacteremia, Japan, 2005–2021*
| Characteristics | No. (%) |
|---|---|
| Type of infection | |
| Community-acquired | 136 (93.2) |
| Nosocomial |
10 (6.8) |
| Clinical source of bacteremia† | |
| Cellulitis | 74 (50.7) |
| Primary bacteremia without focus | 27 (18.5) |
| Necrotizing fasciitis | 10 (6.8) |
| Vertebral osteomyelitis and discitis | 10 (6.8) |
| Psoas abscess | 6 (4.1) |
| Septic arthritis | 11 (7.5) |
| Infectious endocarditis | 4 (2.7) |
| Urinary tract infection | 7 (4.8) |
| Pneumonia | 1 (0.7) |
| Others‡ |
14 (9.6) |
| Clinical characteristics | |
| Body temperature >38°C, n = 143 | 100 (69.9) |
| Mean arterial pressure <80 mm Hg, n = 140 | 42 (30.0) |
| Heart rate >90 beats/min, n = 138 | 83 (60.1) |
| Disturbance of consciousness, n = 141 |
54 (38.3) |
| Severe disease, n = 142 | |
| Streptococcus toxic shock syndrome | 7 (4.9) |
| Vasopressor support required | 11 (7.7) |
| Ventilator support required | 6 (4.2) |
| Admission to intensive care unit required |
9 (6.3) |
| Death | |
| In-hospital death, n = 143 | 10 (7.0) |
| 30-d mortality, n = 138 | 5 (3.6) |
*Data include 13 relapse or reinfection episodes among 9 patients (details are available in Appendix 2 Table 1). †Data include >1 instance per patient, including 3 case-patients with cellulitis and septic arthritis; 2 with vertebral osteomyelitis and psoas abscess; and 1 with each of the following co-infections: cellulitis and vertebral osteomyelitis; cellulitis and psoas abscess; cellulitis and urinary tract infection; necrotizing fasciitis and septic arthritis; vertebral osteomyelitis and septic arthritis; psoas abscess and septic arthritis; infective endocarditis and vertebral osteomyelitis; cellulitis and mycotic aneurysm; vertebral osteomyelitis, psoas abscess, and pyogenic lymphadenitis; vertebral osteomyelitis, psoas abscess, and urinary tract infection; vertebral osteomyelitis, septic arthritis, and empyema. ‡Other infections were 3 cases of catheter-related bloodstream infection; 3 cases of decubitus infection; 2 cases of secondary peritonitis; and 1 case each of empyema; surgical site infection; retroperitoneal abscess; pyogenic lymphadenitis; and mycotic aneurysm.