Biofilm in group A streptococcal necrotizing soft tissue infections

Nikolai Siemens; Bhavya Chakrakodi; Srikanth Mairpady Shambat; Marina Morgan; Helena Bergsten; Ole Hyldegaard; Steinar Skrede; Per Arnell; Martin B Madsen; Linda Johansson; INFECT Study Group; Julius Juarez; Lidija Bosnjak; Matthias Mörgelin; Mattias Svensson; Anna Norrby-Teglund

doi:10.1172/jci.insight.87882

Biofilm in group A streptococcal necrotizing soft tissue infections

Nikolai Siemens, Bhavya Chakrakodi, Srikanth Mairpady Shambat, Marina Morgan, Helena Bergsten, Ole Hyldegaard, Steinar Skrede, Per Arnell, Martin B Madsen, Linda Johansson, INFECT Study Group, Julius Juarez, Lidija Bosnjak, Matthias Mörgelin, Mattias Svensson, Anna Norrby-Teglund

Institut for Klinisk Medicin

29 Citationer (Scopus)

Abstract

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.

Originalsprog	Engelsk
Artikelnummer	e87882
Tidsskrift	JCI insight
Vol/bind	1
Udgave nummer	10
ISSN	2379-3708
DOI	https://doi.org/10.1172/jci.insight.87882
Status	Udgivet - 7 jul. 2019

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Siemens, N., Chakrakodi, B., Shambat, S. M., Morgan, M., Bergsten, H., Hyldegaard, O., Skrede, S., Arnell, P., Madsen, M. B., Johansson, L., INFECT Study Group, Juarez, J., Bosnjak, L., Mörgelin, M., Svensson, M., & Norrby-Teglund, A. (2019). Biofilm in group A streptococcal necrotizing soft tissue infections. JCI insight, 1(10), Artikel e87882. https://doi.org/10.1172/jci.insight.87882

Siemens, N, Chakrakodi, B, Shambat, SM, Morgan, M, Bergsten, H, Hyldegaard, O, Skrede, S, Arnell, P, Madsen, MB, Johansson, L, INFECT Study Group, Juarez, J, Bosnjak, L, Mörgelin, M, Svensson, M & Norrby-Teglund, A 2019, 'Biofilm in group A streptococcal necrotizing soft tissue infections', JCI insight, bind 1, nr. 10, e87882. https://doi.org/10.1172/jci.insight.87882

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abstract = "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.",

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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

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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.

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Biofilm in group A streptococcal necrotizing soft tissue infections

Abstract

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