Soft Tissue Infections of Streptococcal Etiology in the Purulent-Surgical Department of a Multidisciplinary Hospital

Purulent diseases of skin and soft tissues occupy the leading place among surgical infections in terms of frequency of occurrence and possible complications. The most significant etiological agents in surgical infections of soft tissues are group A streptococci (SGA), however, there are known cases of severe invasive infections caused by group B, C, G streptococci and pneumococci.
Aim. To estimate the frequency and identify the features of soft tissue streptococcal infection in patients of the purulent-surgical department of a multidisciplinary hospital in Moscow.
Materials and Methods. We conducted an epidemiological observational descriptive continuous retrospective study based on the analysis of data from case histories of purulent surgery patients with isolation of Streptococcus monocultures obtained from the unified medical information and analytical system (EMIAS) of a multidisciplinary hospital in Moscow for 2020–2022. Establishment of a case of invasive infection was based on the criteria proposed by the US Centers for Disease Control and Prevention (CDC), according to which a case of invasive infection is defined by the isolation of the pathogen from the sterile in normal conditions environment of the organism and laboratory confirmation of infection with clinical signs of invasive disease. Statistical processing and analysis of the study results were performed using Microsoft Excel 2010 and IBM SPSS Statistics 22.
Results. During the study period, 235 cases of skin and soft tissue infections with isolation of Streptococcus monocultures were detected in the department of purulent surgery of a multidisciplinary hospital. The most frequent diagnoses were abscesses – 109 (37,59%), phlegmons – 61 (21,03%), infected wounds – 30 (10,34%), purulent destructive arthritis – 12 (4,14%). The comorbidities identified were hypertension (HD) 21.45%, diabetes mellitus (DM) 19.8%, coronary heart disease (CHD) 12.54%, and hepatitis 4.97%. The age median of all patients was 47 (IQR=20) years. On average, patients spent 9 days in hospital. In 9.79% of cases, the treatment of patients was rather long (>21 days). Among the monocultures of streptococci isolated from patients, S. pyogenes (40.78%), S. agalactiae (22.75%), S. anginosus (13.33%) and S. constellatus (6.27%) were predominant. A total of 32 (13.62%) cases of invasive soft tissue infection were identified during the study period, of which 16 (50.0%) were associated with S. agalactiae monocultures, 9 (28.13%) with S. pyogenes, and the remaining 7 (21.88%) with other streptococcal species. Male patients (87.5%) predominated in the sex and age structure. During the analysed period, mortality in the invasive form of infection was 6.25%. According to the ROC-analysis, the development of the invasive form of infection was predicted in patients aged 52 years and older. The comorbidities most closely associated with the invasive form of infection were diabetes mellitus DM (OR = 4.2), GB (OR = 2.7), CHD (OR = 4.8) and gastrointestinal inflammatory disease (OR = 14.3).
Conclusion. The study demonstrated a wide prevalence of soft tissue streptococcal infection in the department of purulent surgery of a multidisciplinary hospital with the predominance of S. pyogenes, S. agalactiae, S. anginosus and S. constellatus in the etiological structure and showed the possibility of developing invasive forms of the disease associated not only with group A streptococci, but also with other species of streptococci.

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