Biofilm in group A streptococcal necrotizing soft tissue infections

• DOI: 10.1172/jci.insight.87882
• Publication Date: 2016-07-06T15:00:57Z
• Authors: Nikolai Siemens; Bhavya Chakrakodi; Srikanth Mairpady...; Marina Morgan; Helena Bergsten; Ole Hyldegaard; Steinar Skrede; Per Arnell; Martin B. Madsen; Linda Johansson; ; Julius Juarez; Lidija Bosnjak; Matthias Mörgelin; Mattias Svensson; Anna Norrby-Teglund
• Keywords: Group A

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