Role of viral coinfection in post-pandemic invasive Group A streptococcal infections in adults, a nation-wide cohort study (iGASWISS)

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OBJECTIVE: During the winter season of 2022-2023, numerous countries experienced a surge in invasive Streptococcus pyogenes (iGAS) infections. The role of viral coinfections in the post-COVID surge has not been elucidated. We report nation-wide data describing clinical presentation, microbiological characteristics, and associations with viral infection in adults during this period. METHODS: A multicenter retrospective cohort study was conducted across 10 hospitals in Switzerland, including adults (> 16 years old) with iGAS infection from November 2022 to February 2023. Descriptive analysis was performed. A multivariable logistic regression model was fitted to assess the impact of viral coinfection. In addition, genetic analysis was performed in available isolates. RESULTS: A total of 194 patients were included, with a median age of 50 years (interquartile range [IQR]: 37-69). 17/194 (8.8%) were immunosuppressed and 40/194 (20.6%) exhibited concomitant viral infections, predominantly Influenza A (21/40, 53%). Illness severity was high: 65/194 (33.5%) of cases necessitated admission to an intensive care unit (ICU), and the 30-day mortality was 4% (n = 8). Among the available strains for genetic analysis (n = 48), heterogeneity was found although ST28-emm1 isolates (also known as M1UK) was predominant (22/48). CONCLUSION: The post-COVID iGAS surge in Switzerland was associated with high levels of morbidity and mortality in immunocompetent adults. M1UK was predominant within the iGAS strains circulating in Switzerland during the study period and viral coinfection was a predictor for ICU admission and mortality.

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