Nicolas Dauby1, Véronique Yvette Miendje Deyi2, Valérie Delforge3, Delphine Martiny4, Leila Mekkaoui5, Marie Hallin6, Romain Mahieu7, Nathalie Bossuyt8, Anne Botteaux9, Pierre R Smeesters10. 1. Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium; Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB). Electronic address: Nicolas.dauby@ulb.ac.be. 2. Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium. Electronic address: Veronique.MIENDJEDEYI@lhub-ulb.be. 3. Molecular Bacteriology Laboratory, Université Libre de Bruxelles (ULB), Brussels, Belgium. Electronic address: valerie.delforge@ulb.ac.be. 4. Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium; Université de Mons (UMONS), Mons, Belgium. Electronic address: delphine.martiny@lhub-ulb.be. 5. Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium. Electronic address: leila.mekkaoui@lhub-ulb.be. 6. Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium. Electronic address: marie.hallin@lhub-ulb.be. 7. Hygiene Inspection, Comission Communautaire Commune, Brussels-Capital Region, Brussels, Belgium. Electronic address: rmahieu@ccc.brussels. 8. Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium. Electronic address: Nathalie.Bossuyt@sciensano.be. 9. Molecular Bacteriology Laboratory, Université Libre de Bruxelles (ULB), Brussels, Belgium. Electronic address: Anne.Botteaux@ulb.ac.be. 10. Molecular Bacteriology Laboratory, Université Libre de Bruxelles (ULB), Brussels, Belgium; Queen Fabiola Children University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium; Murdoch Children's Research Institute, Melbourne, Australia; Centre for International Child Health, University of Melbourne, Melbourne, Australia. Electronic address: psmeeste@ulb.ac.be.
Abstract
OBJECTIVES: The aim was to characterize the clinical features, outcomes, and strain diversity of laboratory-confirmed Streptococcus pyogenes (group A Streptococcus, GAS) infections among inpatients hospitalized at a tertiary level hospital in Brussels, Belgium, according to the patients' housing status (homeless vs. not homeless). METHODS: Between August 2016 and January 2018, all patients hospitalized with a laboratory-confirmed GAS infection were prospectively enrolled and risk factors were recorded. GAS strains were characterized using emm-typing and emm-clustering in both inpatients and outpatients. Analyses were performed according to homelessness status. RESULTS: During the study period, 48% (28/58) of adults hospitalized with a GAS infection at the tertiary hospital were homeless. The estimated incidence rate was 100 times higher for homeless persons. Skin abscesses were more frequent in the homeless group (21.4% vs. 3.3%) and mortality was high (10.7%). Limited emm-type diversity was found in this group, with four emm-types (64, 77, 83, and 101) accounting for 76.1% of the infections, and the majority of these emm-types belonged to the D4 emm-cluster. Pooled analyses of inpatient and outpatient strains indicated lower diversity in the homeless group. CONCLUSIONS: The homeless are disproportionately affected by GAS and have a higher rate of abscesses and high mortality. The lower emm-type diversity and preferential infection with four emm-types likely reflects endemic circulation of GAS in this population. Preventive strategies are warranted in this fragile population.
OBJECTIVES: The aim was to characterize the clinical features, outcomes, and strain diversity of laboratory-confirmed Streptococcus pyogenes (group A Streptococcus, GAS) infections among inpatients hospitalized at a tertiary level hospital in Brussels, Belgium, according to the patients' housing status (homeless vs. not homeless). METHODS: Between August 2016 and January 2018, all patients hospitalized with a laboratory-confirmed GAS infection were prospectively enrolled and risk factors were recorded. GAS strains were characterized using emm-typing and emm-clustering in both inpatients and outpatients. Analyses were performed according to homelessness status. RESULTS: During the study period, 48% (28/58) of adults hospitalized with a GAS infection at the tertiary hospital were homeless. The estimated incidence rate was 100 times higher for homeless persons. Skin abscesses were more frequent in the homeless group (21.4% vs. 3.3%) and mortality was high (10.7%). Limited emm-type diversity was found in this group, with four emm-types (64, 77, 83, and 101) accounting for 76.1% of the infections, and the majority of these emm-types belonged to the D4 emm-cluster. Pooled analyses of inpatient and outpatient strains indicated lower diversity in the homeless group. CONCLUSIONS: The homeless are disproportionately affected by GAS and have a higher rate of abscesses and high mortality. The lower emm-type diversity and preferential infection with four emm-types likely reflects endemic circulation of GAS in this population. Preventive strategies are warranted in this fragile population.
Authors: Michel Roland; Louisa Ben Abdelhafidh; Victoria Déom; Frank Vanbiervliet; Yves Coppieters; Judith Racapé Journal: PLoS One Date: 2021-06-15 Impact factor: 3.240