BACKGROUND: Since 2022, an increasing number of invasive group A streptococcal (iGAS) infections have been reported, with increasing severity and lethality. We aimed to compare the frequency and characteristics of bacteraemic GAS infections in adults before and after the COVID-19 pandemic. METHODS: This was a retrospective observational study of adult patients with Streptococcus pyogenes bacteraemia in two periods, January 2017 to December 2019 and October 2022 to December 2023. Demographics, clinical presentation, antibiotic treatment, therapeutic response, complications and outcome were analysed. RESULTS: Thirty-five patients with Streptococcus pyogenes bacteraemia in the 3-year pre-pandemic group were compared with 36 patients in the 15-month post-pandemic group. The median ages in the pre-pandemic and post-pandemic groups were 65 (IQR = 28) and 64.5 (IQR = 31) years, respectively. The proportions of males and females in the pre-pandemic group were 69% and 31%, respectively, compared with 33% and 67%, respectively, in the post-pandemic group. Skin and soft tissue infections occurred in 77% and 53%, respectively (p = 0.032). Rare manifestations, such as pneumonia and meningitis, were diagnosed in the post-pandemic group. Septic shock was significantly less common in the pre-pandemic group, with rates of 26% vs. 56% (p = 0.011). Treatment response was good in 74% of the pre-pandemic group compared to 58% of the post-pandemic group (p = 0.155). Lethality was not significantly higher in the post-pandemic group (26% vs. 33%, p = 0.482) but the number of deaths per year was more than three times higher in the post-pandemic group. CONCLUSIONS: In the post-pandemic period, the frequency of bacteraemic GAS infections in adults increased significantly. A higher proportion of women, a decrease in the age of women and an increase in the age of men, rare clinical manifestations, poor response to therapy and increased severity and number of deaths were the new features of adult disease observed in the post-pandemic period.

• Keywords
• Streptococcus pyogenes, Bacteraemia, Beta-haemolytic Streptococci, Group A streptococcus,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Bacteremia * epidemiology   microbiology   drug therapy   MeSH
• COVID-19 * epidemiology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Retrospective Studies MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Streptococcus pyogenes * MeSH
• Streptococcal Infections * epidemiology   drug therapy   microbiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH

AIMS: Since December 2022, an increase in invasive disease caused by Streptococcus pyogenes has been observed in the Czech Republic, with a shift in the clinical presentation and age of patients. Unlike in previous years, invasive disease is more common in children and adolescents under 18 years of age and in previously healthy middle-aged adults. An increase has been noticed in the number of S. pyogenes isolates from primarily sterile sites such as haemoculture, cerebrospinal fluid, pleural effusion fluid, joint fluid, and postmortem specimens. Routine emm gene typing revealed emm1 to be the predominant emm type of S. pyogenes. Between January 2023 and July 2023, 46% of all S. pyogenes isolates from invasive cases were assigned to the emm1 type. The globally spread M1UK sublineage is characterized by differences in the expression of seven genes, including the streptococcal pyrogenic toxin A (speA) gene, compared to historical emm1 iGAS strains. The aim of this study is to determine whether the more toxigenic M1UK sublineage is associated with the increase in invasive disease in the Czech Republic. METHODS: Whole genome sequencing of 41 S. pyogenes isolates from patients with invasive disease recovered in the Czech Republic in 2018 and 2019 and from December 2022 to May 2023 was performed using the MiSeq instrument (Illumina). Bioinformatics analysis was performed using freely available online tools the Bacterial and Viral Bioinformatics Resource Center. RESULTS: Based on whole genome sequencing data of 41 emm1 isolates of S. pyogenes from patients with invasive infectious disease recovered in 2018 and 2019 and from December 2022 to May 2023, the M1UK sublineage was found to be predominant from December 2022 to May 2023. CONCLUSION: The reason for the spread of the M1UK sublineage in the Czech Republic late in 2022 and in the first half of 2023 is not entirely clear, but it may be related to reduced immunity due to limited GAS transmission during lockdowns, especially in children. Another factor that may have contributed to the high incidence of invasive infectious diseases is the seasonal circulation of respiratory viruses.

• Keywords
• GAS, Phylogenetic analysis, Streptococcus pyogenes, outbreak iGAS, superantigen, whole genome sequencing,
• MeSH
• Antigens, Bacterial * genetics   MeSH
• Bacterial Proteins genetics   MeSH
• Child MeSH
• Adult MeSH
• Exotoxins genetics   MeSH
• Infant MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Child, Preschool MeSH
• Prevalence MeSH
• Bacterial Outer Membrane Proteins * genetics   MeSH
• Aged MeSH
• Streptococcus pyogenes * genetics   isolation & purification   MeSH
• Streptococcal Infections * microbiology   epidemiology   MeSH
• Carrier Proteins * genetics   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Infant MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Child, Preschool MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Names of Substances
• Antigens, Bacterial * MeSH
• Bacterial Proteins MeSH
• Exotoxins MeSH
• Bacterial Outer Membrane Proteins * MeSH
• streptococcal M protein MeSH Browser
• Carrier Proteins * MeSH

Streptococcus pyogenes causes a variety of human diseases ranging from uncomplicated respiratory tract and skin infections to severe invasive diseases possibly involving toxic shock syndrome. Besides the emm gene-encoded M protein, important virulence factors are pyrogenic exotoxins, referred to as superantigens. The National Reference Laboratory for Streptococcal Infections has newly introduced bioinformatics tools for processing S. pyogenes whole genome sequencing data. Using the SRST2 software and BV-BRC platform, WGS data of 10 S. pyogenes isolates from patients with invasive disease were analysed, and emm type, sequence type, and superantigen encoding gene profiles were determined. The Unicycler assembly pipeline with the SPAdes de novo assembler was used to assemble genome sequences from short reads.

• Keywords
• GAS, Streptococcus pyogenes, superantigen, whole genome sequencing,
• MeSH
• Antigens, Bacterial genetics   MeSH
• Virulence Factors genetics   MeSH
• Humans MeSH
• Whole Genome Sequencing MeSH
• Streptococcus pyogenes * genetics   MeSH
• Streptococcal Infections * MeSH
• Superantigens genetics   analysis   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Antigens, Bacterial MeSH
• Virulence Factors MeSH
• Superantigens MeSH

Neonatal osteomyelitis (OM), although exceptionally rare, has been linked to detrimental sequel, as diagnosis in the early stages is challenging and any delay in treatment can lead to disturbance in skeletal growth. In pediatric OM the most commonly grown bacteria is Staphylococcus aureus followed by group A Streptococcus (GAS). Notwithstanding, sepsis-induced coagulopathy is a well-known entity in children and adults, still sepsis-associated thrombosis is sparsely observed. we present a case of a newborn with GAS associated OM and thrombosis. A term neonate on the 11th day of life was referred to our NICU due to right (R) lower limb edema, cyanosis and core temperature up to 39 °C. Late onset sepsis was suspected and started on vancomycin and amikacin. A colour Doppler scan showed thrombosis of the R common femoral vein. The neonate started on iv unfractionated heparin. Ampicillin was added given positive for GAS blood culture. An MRI on the 5th day of admission, showed evidence of thrombosis resolution. On the 14th day of admission, a bone Tc99 scan showed evidence of OM of R femur. Antibiotic treatment switched to amoxicillin per os. The management was restricted to anticoagulant therapy with low molecular weight heparin for 3 months and antibiotic therapy for 6 months without surgery intervention and the patient recovered and discharged at 42 days of age. Early diagnosis and treatment of neonatal osteomyelitis can prevent bone destruction. Sepsis-associated thrombosis is barely observed during osteomyelitis, yet it should be considered as an emerged case requiring prompt treatment.

• Keywords
• Neonate, Osteomyelitis, Streptococcus, Thrombosis,
• MeSH
• Amoxicillin MeSH
• Child MeSH
• Adult MeSH
• Heparin MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Osteomyelitis * complications   diagnosis   MeSH
• Streptococcus pyogenes MeSH
• Streptococcal Infections * complications   diagnosis   drug therapy   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Amoxicillin MeSH
• Heparin MeSH

OBJECTIVE: Group A beta-haemolytic streptococci (GAS), which are responsible for most cases of acute bacterial tonsillopharyngitis, are transmitted from person to person and may rarely cause foodborne outbreaks. This study aims to report the epidemic caused by GAS in our hospital and to draw attention to the explosive outbreaks of the bacteria. METHODS: Acute tonsillopharyngitis was seen in 201 of 450 hospital employees who ate in the hospital cafeteria on 4-5 June 2015. RESULTS: GAS was detected in 106 (68%) of 157 cases and in 40 (63.5%) of 62 throat culture samples. The attack rate was 44.7%. The most suspected source of the outbreak was a food handler who had been showing signs of streptococcal tonsillopharyngitis for six days, and perhaps the food prepared by these staff. CONCLUSION: It should not be forgotten that GAS can cause explosive outbreaks by infecting food through hand lesions or mouth secretions of food service personnel.

• Keywords
• GAS, Streptococcus pyogenes, foodborne, outbreak, streptococcal tonsillopharyngitis,
• MeSH
• Disease Outbreaks MeSH
• Pharyngitis * epidemiology   diagnosis   microbiology   MeSH
• Humans MeSH
• Hospitals MeSH
• Streptococcus pyogenes MeSH
• Streptococcal Infections * epidemiology   diagnosis   microbiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

While the inhalation of Thymus vulgaris L. essential oil (EO) is commonly approved for the treatment of mild respiratory infections, there is still a lack of data regarding the antimicrobial activity and chemical composition of its vapours. The antibacterial activity of the three T. vulgaris EOs against respiratory pathogens, including Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pyogenes, was assessed in both liquid and vapour phases using the broth microdilution volatilisation (BMV) method. With the aim of optimising a protocol for the characterisation of EO vapours, their chemical profiles were determined using two headspace sampling techniques coupled with GC/MS: solid-phase microextraction (HS-SPME) and syringe headspace sampling technique (HS-GTS). All EO sample vapours exhibited antibacterial activity with minimum inhibitory concentrations (MIC) ranging from 512 to 1024 μg/mL. According to the sampling technique used, results showed a different distribution of volatile compounds. Notably, thymol was found in lower amounts in the headspace-peak percentage areas below 5.27% (HS-SPME) and 0.60% (HS-GTS)-than in EOs (max. 48.65%), suggesting that its antimicrobial effect is higher in vapour. Furthermore, both headspace sampling techniques were proved to be complementary for the analysis of EO vapours, whereas HS-SPME yielded more accurate qualitative results and HS-GTS proved a better technique for quantitative analysis.

• Keywords
• antimicrobial activity, broth microdilution, headspace analysis, respiratory infections, thyme, vapour phase,
• MeSH
• Anti-Bacterial Agents chemistry   isolation & purification   pharmacology   MeSH
• Haemophilus influenzae drug effects   MeSH
• Microbial Sensitivity Tests MeSH
• Solid Phase Microextraction * MeSH
• Oils, Volatile chemistry   isolation & purification   pharmacology   MeSH
• Gas Chromatography-Mass Spectrometry MeSH
• Staphylococcus aureus drug effects   MeSH
• Streptococcus pyogenes drug effects   MeSH
• Thymus Plant chemistry   MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH
• Oils, Volatile MeSH

In this study, a new broth macrodilution volatilization method for the simple and rapid determination of the antibacterial effect of volatile agents simultaneously in the liquid and vapor phase was designed with the aim to assess their therapeutic potential for the development of new inhalation preparations. The antibacterial activity of plant volatiles (β-thujaplicin, thymohydroquinone, thymoquinone) was evaluated against bacteria associated with respiratory infections (Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes) and their cytotoxicity was determined using a modified thiazolyl blue tetrazolium bromide assay against normal lung fibroblasts. Thymohydroquinone and thymoquinone possessed the highest antibacterial activity against H. influenzae, with minimum inhibitory concentrations of 4 and 8 µg/mL in the liquid and vapor phases, respectively. Although all compounds exhibited cytotoxic effects on lung cells, therapeutic indices (TIs) suggested their potential use in the treatment of respiratory infections, which was especially evident for thymohydroquinone (TI > 34.13). The results demonstrate the applicability of the broth macrodilution volatilization assay, which combines the principles of broth microdilution volatilization and standard broth macrodilution methods. This assay enables rapid, simple, cost- and labor-effective screening of volatile compounds and overcomes the limitations of assays currently used for screening of antimicrobial activity in the vapor phase.

• Keywords
• antimicrobial, cytotoxicity, macrodilution method, respiratory infections, thymohydroquinone, thymoquinone, vapor phase, volatile compound, β-thujaplicin,
• MeSH
• Anti-Bacterial Agents analysis   chemistry   pharmacology   MeSH
• Administration, Inhalation MeSH
• Bacteria drug effects   MeSH
• Benzoquinones administration & dosage   pharmacology   MeSH
• Haemophilus influenzae drug effects   MeSH
• Microbial Sensitivity Tests MeSH
• Monoterpenes administration & dosage   pharmacology   MeSH
• Oils, Volatile chemistry   pharmacology   MeSH
• Staphylococcus aureus drug effects   MeSH
• Streptococcus pneumoniae drug effects   MeSH
• Streptococcus pyogenes drug effects   MeSH
• Volatile Organic Compounds chemistry   pharmacology   MeSH
• Thymol administration & dosage   analogs & derivatives   pharmacology   MeSH
• Tropolone administration & dosage   analogs & derivatives   pharmacology   MeSH
• Volatilization MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH
• Benzoquinones MeSH
• beta-thujaplicin MeSH Browser
• Monoterpenes MeSH
• Oils, Volatile MeSH
• Volatile Organic Compounds MeSH
• thymohydroquinone MeSH Browser
• Thymol MeSH
• thymoquinone MeSH Browser
• Tropolone MeSH

Úvod: Biomarkery jsou u septických pacientů využívány jak k diagnostice sepse, tak k antibiotickému stewardshipu. Sepse vyvolaná gramnegativními bakteriemi mívá odlišné charakteristiky, především vysoký prokalcitonin vs C-reaktivní protein v porovnání se sepsí vyvolanou grampozitivními bakteriemi. Avšak jednotlivá infekční agens, především Streptococcus pyogenes, nemusí do tohoto schématu zapadat, což může vest k nesprávné iniciální volbě antibiotika. Metody: Retrospektivní analýza biomarkerů, iniciální volby antibiotické léčby a výsledků léčby u pacientů se sepsí vyvolanou S. pyogenes, Escherichia coli a Staphylococcus aureus. Hodnoty biomarkerů byly porovnány pomocí Kruskal-Wallis testu s následným Dunn post-Hoc testem s prahem p < 0,05. Výsledky: Hodnoty prokalcitoninu byly nejvyšší u sepse vyvolané S. pyogenes (12,51 ng/ml, IQR: 6,26-48,38 ng/ml) oproti sepsi vyvolaná E. coli (4,30 ng/ml, IQR: 1,50-10,00 ng/ml, p < 0,001) a S. aureus (0,75 ng/ml, QR: 0,34-1,62 ng/ml, p < 0,001). Poměr neutrofilů a lymfocytů vykazoval stejné charakteristiky jako prokalcitonin. Správná iniciální antibiotická léčba byla v souboru S. pyogenes 11,29 % v porovnání s 99,3 % a 100 % u S. aureus a E. coli skupin. Závěr: Oproti předchozím studiím byly v našem souboru pozorovány nejvyšší hodnoty prokalcitoninu u pacientů se sepsí vyvolanou S. pyogenes spíše než gramnegativními bakteriemi. Vysoké hodnoty prokalcitoninu imitující gramnegativní zánětlivou odpověď přispěli k ovlivnění výběru iniciální antibiotické léčby (bez znalosti původce), což mohlo vést k vyšší mortalitě u této skupiny pacientů. Proto doporučujeme přehodnocení významu prokalcitoninu v diagnostice sepse pro zlepšení přežití i kvality života pacientů.

• Keywords
• biomarkery, iniciální ATB terapie, klindamycin, poměr neutrofilů/lymfocytů, prokalcitonin, sepse,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Biomarkers MeSH
• Escherichia coli MeSH
• Sepsis drug therapy   MeSH
• Staphylococcus aureus MeSH
• Streptococcus pyogenes * MeSH
• Streptococcal Infections drug therapy   MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH
• Biomarkers MeSH

Peritonsillar abscess (PTA) is the most common complication of tonsillitis. Cultivation usually reveals a wide spectrum of aerobic and anaerobic microbiota. This retrospective study compared PTA incidence and the spectrum of individual microbial findings in groups of patients divided by gender, age, and season. Of the 966 samples cultivated, a positive cultivation finding was detected in 606 patients (62.73%). Cultivation findings were negative in 360 (37.27%), meaning no pathogen was present or only common microbiota was cultivated. The highest incidence of PTA was found in group I patients (19-50 years) (p ≤ 0.0001) and the most frequently cultured pathogens was Streptococcus pyogenes (36.23%). Gender seemed to have an influence on the results, with higher incidence found in males (p ≤ 0.0001). The analysis of correlation between PTA incidence and season did not yield statistically significant results (p = 0.4396) and no statistically significant differences were observed in individual pathogen frequency. PTA had a higher incidence in adult males and a slightly higher incidence in girls in childhood. The following findings are clinically significant and have implications for antibiotic treatment strategy: (1) the most frequently cultivated pathogen was Streptococcus pyogenes; (2) an increased incidence of anaerobes was proven in the oldest group (>50 years).

• Keywords
• bacteriology, incidence, patient stratification, peritonsillar abscess, personalized treatment, primary prevention,
• MeSH
• Anti-Bacterial Agents MeSH
• Child MeSH
• Adult MeSH
• Incidence MeSH
• Humans MeSH
• Peritonsillar Abscess epidemiology   microbiology   MeSH
• Retrospective Studies MeSH
• Streptococcus pyogenes MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH

Background: Necrotizing fasciitis is a major health problem throughout the world. The purpose of this review is to assist providers with the care of these patients through a better understanding of the pathophysiology and management options. Methods: This is a collaborative review of the literature between members of the Surgical Infection Society of North America and World Society of Emergency Surgery. Results: Necrotizing fasciitis continues to be difficult to manage with the mainstay being early diagnosis and surgical intervention. Recognition of at-risk populations assists with the initiation of treatment, thereby impacting outcomes. Conclusions: Although there are some additional treatment strategies available, surgical debridement and antimicrobial therapy are central to the successful eradication of the disease process.

• Keywords
• fasciitis, infection, necrotizing,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Debridement methods   MeSH
• Fasciitis, Necrotizing blood   diagnosis   physiopathology   therapy   MeSH
• Risk Assessment MeSH
• Soft Tissue Infections blood   diagnosis   physiopathology   therapy   MeSH
• Clostridium Infections physiopathology   therapy   MeSH
• Humans MeSH
• Risk Factors MeSH
• Staphylococcal Infections physiopathology   therapy   MeSH
• Staphylococcus aureus MeSH
• Streptococcus pyogenes MeSH
• Streptococcal Infections physiopathology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH