TY - JOUR

T1 - Biofilm in group A streptococcal necrotizing soft tissue infections

AU - Siemens, Nikolai

AU - Chakrakodi, Bhavya

AU - Shambat, Srikanth Mairpady

AU - Morgan, Marina

AU - Bergsten, Helena

AU - Hyldegaard, Ole

AU - Skrede, Steinar

AU - Arnell, Per

AU - Madsen, Martin B

AU - Johansson, Linda

AU - INFECT Study Group

AU - Juarez, Julius

AU - Bosnjak, Lidija

AU - Mörgelin, Matthias

AU - Svensson, Mattias

AU - Norrby-Teglund, Anna

PY - 2016

Y1 - 2016

N2 - Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign devices. Here, we present a case of a previously healthy male presenting with NSTI caused by GAS. The infection persisted over 24 days, and the surgeon documented the presence of a "thick layer biofilm" in the fascia. Subsequent analysis of NSTI patient tissue biopsies prospectively included in a multicenter study revealed multiple areas of biofilm in 32% of the patients studied. Biopsies associated with biofilm formation were characterized by massive bacterial load, a pronounced inflammatory response, and clinical signs of more severe tissue involvement. In vitro infections of a human skin tissue model with GAS NSTI isolates also revealed multilayered fibrous biofilm structures, which were found to be under the control of the global Nra gene regulator. The finding of GAS biofilm formation in NSTIs emphasizes the urgent need for biofilm to be considered as a potential complicating microbiological feature of GAS NSTI and, consequently, emphasizes reconsideration of antibiotic treatment protocols.

AB - Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign devices. Here, we present a case of a previously healthy male presenting with NSTI caused by GAS. The infection persisted over 24 days, and the surgeon documented the presence of a "thick layer biofilm" in the fascia. Subsequent analysis of NSTI patient tissue biopsies prospectively included in a multicenter study revealed multiple areas of biofilm in 32% of the patients studied. Biopsies associated with biofilm formation were characterized by massive bacterial load, a pronounced inflammatory response, and clinical signs of more severe tissue involvement. In vitro infections of a human skin tissue model with GAS NSTI isolates also revealed multilayered fibrous biofilm structures, which were found to be under the control of the global Nra gene regulator. The finding of GAS biofilm formation in NSTIs emphasizes the urgent need for biofilm to be considered as a potential complicating microbiological feature of GAS NSTI and, consequently, emphasizes reconsideration of antibiotic treatment protocols.

KW - Journal Article

U2 - 10.1172/jci.insight.87882

DO - 10.1172/jci.insight.87882

M3 - Journal article

C2 - 27699220

VL - 1

JO - JCI Insight

JF - JCI Insight

SN - 2379-3708

IS - 10

M1 - e87882

ER -