Volume 31, Number 2—February 2025
CME ACTIVITY - Research
Streptococcus pyogenes emm Type 3.93 Emergence, the Netherlands and England
Matthew A. Davies1, Brechje de Gier1, Rebecca L. Guy, Juliana Coelho, Alje P. van Dam, Robin van Houdt, Sébastien Matamoros, Marit van den Berg, Patrick E. Habermehl, Kartyk Moganeradj, Yan Ryan, Steve Platt, Henry Hearn, Eleanor Blakey, Darren Chooneea, Bart J.M. Vlaminckx, Theresa Lamagni, and Nina M. van Sorge
Table 1
Characteristics of patients with invasive group A Streptococcus infection in the Netherlands and England caused by emm3.93 or other emm types during November 1, 2023–March 31, 2024*
| Characteristic |
The Netherlands |
England |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| emm3.93, no. (%) |
Other emm type, no. (%) |
aOR (95% CI) |
p value |
emm3.93, no. (%) |
Other emm type, no. (%) |
aOR (95% CI) |
p value |
|||
| No. patients |
319 |
346 |
240 |
1,158 |
||||||
| Age group, y | ||||||||||
| 0–5 | 23 (7.2) | 17 (4.9) | 1.5 (0.7–3.2) | 0.2675 | 30 (12.5) | 93 (8.0) | 1.7 (1.1–2.8) | 0.030 | ||
| 6–17 | 33 (10.3) | 16 (4.6) | 2.4 (1.2–5.0) | 0.0139 | 30 (12.5) | 60 (5.2) | 2.4 (1.4–3.9) | 0.001 | ||
| 18–44 | 65 (20.4) | 112 (32.4) | 0.6 (0.4–0.9) | 0.0204 | 31 (12.9) | 284 (24.5) | 0.6 (0.4–0.9) | 0.022 | ||
| 45–64 | 76 (23.8) | 84 (24.3) | 0.9 (0.6–1.3) | 0.5046 | 63 (26.3) | 258 (22.3) | 1.4 (0.9–2.0) | 0.103 | ||
| >65 |
122 (38.2) |
117 (33.8) |
Referent |
86 (35.8) |
463 (40.0) |
Referent |
||||
| Sex | ||||||||||
| M | 151 (47.3) | 159 (46.0) | Referent | 123 (51.3) | 667 (57.6) | Referent | ||||
| F |
168 (52.7) |
187 (54.0) |
1.1 (0.8–1.5) |
0.5416 |
115 (47.9) |
477 (41.2) |
1.4 (1.0–1.8) |
0.033 |
||
| STSS | ||||||||||
| No | 265 (88.9) | 318 (95.2) | Referent | |||||||
| Yes |
33 (11.1) |
16 (4.8) |
2.2 (1.1–4.3) |
0.0225 |
||||||
| Necrotizing fasciitis | ||||||||||
| No | 279 (93.6) | 302 (90.4) | Referent | |||||||
| Yes |
19 (6.4) |
32 (9.6) |
0.7 (0.4–1.4) |
0.3468 |
||||||
| Puerperal fever or sepsis | ||||||||||
| No | 270 (90.6) | 273 (81.7) | Referent | |||||||
| Yes |
28 (9.4) |
61 (18.3) |
0.5 (0.3–0.8) |
0.004 |
||||||
| Meningitis† | ||||||||||
| No | 286 (96.0) | 328 (98.2) | Referent | 228 (98.3) | 1,058 (99.9) | Referent | ||||
| Yes |
12 (4.0) |
6 (1.8) |
2.7 (0.9–8.8) |
0.0818 |
4 (1.7) |
1 (0.1) |
28.6 (2.6–320.1) |
0.006 |
||
| Bone or joint infection‡ | ||||||||||
| No | 271 (90.9) | 312 (93.4) | Referent | 221 (95.3) | 1,006 (95.0) | Referent | ||||
| Yes |
27 (9.1) |
22 (6.6) |
1.2 (0.6–2.4) |
0.586 |
11 (4.7) |
53 (5.0) |
1.1 (0.6–2.3) |
0.858 |
||
| Pneumonia/pleural empyema§ | ||||||||||
| No | 217 (72.8) | 298 (89.2) | Referent | 218 (94.3) | 1,039 (98.1) | Referent | ||||
| Yes |
81 (27.2) |
36 (10.8) |
2.9 (1.9–4.6) |
<0.001 |
14 (6.0) |
20 (1.9) |
3.4 (1.6–73) |
0.001 |
||
| Cardiovascular infection | ||||||||||
| No | 297 (99.7) | 329 (98.5) | Referent | |||||||
| Yes |
1 (0.3) |
5 (1.5) |
0.2 (0.0–1.8) |
0.2252 |
||||||
| Skin and soft tissue infection | ||||||||||
| No | 260 (87.2) | 264 (79.0) | Referent | |||||||
| Yes |
38 (12.8) |
70 (21.0) |
0.5 (0.3–0.8) |
0.0032 |
||||||
| Sepsis | ||||||||||
| No | 231 (77.5) | 240 (71.9) | Referent | |||||||
| Yes |
67 (22.5) |
94 (28.1) |
0.7 (0.5–1.0) |
0.055 |
||||||
| Month | ||||||||||
| 2023 Nov | 4 (1.3) | 63 (18.2) | Referent | 9 (3.8) | 218 (18.8) | Referent | ||||
| 2023 Dec | 60 (18.8) | 74 (21.4) | 12.5 (4.8–43.2) | <0.0001 | 44 (18.3) | 223 (19.3) | 4.7 (2.2–9.9) | <0.0001 | ||
| 2024 Jan | 86 (27.0) | 73 (21.1) | 19.1 (7.3–65.6) | <0.0001 | 61 (25.4) | 258 (22.3) | 5.7 (2.8–11.8) | <0.0001 | ||
| 2024 Feb | 102 (32.0) | 69 (19.9) | 24.1 (9.3–82.6) | <0.0001 | 62 (25.8) | 227 (19.6) | 6.3 (3.1–13.2) | <0.0001 | ||
| 2024 Mar | 67 (21.0) | 67 (19.4) | 14.8 (5.7–51.2) | <0.0001 | 64 (26.7) | 232 (20.0) | 6.7 (3.2–13.8) | <0.0001 | ||
*Odds ratios for age group, sex, and month are derived from a multivariable model containing those 3 variables. Odds ratios for clinical manifestations are adjusted for age group, sex, and month, but the puerperal fever or sepsis aOR is adjusted for month only. aOR, adjusted odds ratio; STSS, streptococcal toxic shock syndrome. †Cerebral spinal fluid specimens used as proxy in data from England. ‡Joint or synovial fluid specimens used for data from England. §Pleural specimens used as proxy for data from England.
1These authors contributed equally.
Page created: December 30, 2024
Page updated: February 24, 2025
Page reviewed: February 24, 2025
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
Content Credential