7c34e2583c7d452fd030b976bb96c2e0 336545.pdf ff64a6f57e9f94ad39880c18092d67ebddfae53a 336545.pdf 300a10a370dd5dd5b9fcd7711bee5d7f6fe86423f85c39780035c312c06cad62 336545.pdf Title: Catastrophic Streptococcus pyogenes Disease: A Personalized Approach Based on Phenotypes and Treatable Traits Subject: Streptococcal toxic shock syndrome (STTS) is a critical medical emergency marked by high morbidity and mortality, necessitating swift awareness, targeted treatment, and early source control due to its rapid symptom manifestation. This report focuses on a cohort of 13 patients admitted to Vall d’Hebron University Hospital Intensive Care Unit, Barcelona, from November 2022 to March 2023, exhibiting invasive Streptococcus pyogenes infections and meeting institutional sepsis code activation criteria. The primary infections were community-acquired pneumonia (61.5%) and skin/soft tissue infection (30.8%). All patients received prompt antibiotic treatment, with clinical source control through thoracic drainage (30.8%) or surgical means (23.1%). Organ support involved invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy as per guidelines. Of note, 76.9% of patients experienced septic cardiomyopathy, and 53.8% required extracorporeal membrane oxygenation (ECMO). The study identified three distinct phenotypic profiles—hyperinflammatory, low perfusion, and hypogammaglobulinemic—which could guide personalized therapeutic approaches. STTS, with a mean SOFA score of 17 (5.7) and a 53.8% requiring ECMO, underscores the need for precision medicine-based rescue therapies and sepsis phenotype identification. Integrating these strategies with prompt antibiotics and efficient source control offers a potential avenue to mitigate organ failure, enhancing patient survival and recovery in the face of this severe clinical condition. Keywords: severe sepsis; septic shock; multiorgan dysfunction; precision medicine; hemoadsorption; S. pyogenes; sepsis phenotypes; streptococcal toxic shock syndrome Author: Juan Carlos Ruiz-Rodríguez, Luis Chiscano-Camón, Carolina Maldonado, Adolf Ruiz-Sanmartin, Laura Martin, Ivan Bajaña, Juliana Bastidas, Rocio Lopez-Martinez, Clara Franco-Jarava, Juan José González-López, Vicent Ribas, Nieves Larrosa, Jordi Riera, Xavier Nuvials-Casals and Ricard Ferrer Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Thu Feb 15 10:42:03 2024 CET ModDate: Thu Feb 15 10:43:45 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 300237 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 USLSEY+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 VPAGRI+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 GSQIHA+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 MKZUSU+URWPalladioL-BoldItal Type 1 Custom yes yes yes 32 0 HKBJPQ+VnURWPalladioL Type 1 Custom yes yes yes 37 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 54 0 VSPIKV+CMSY10 Type 1 Builtin yes yes yes 74 0 LWLIVD+EURM10 Type 1 Builtin yes yes yes 107 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-10-01 04:12:16 CEST RepresentationInformation: 336545.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-09-30 10:46:47 CEST Size: 300237 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 302 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Children: Item: Title: Streptococcal Pathophysiology Destination: subsection.1.1 Item: Title: Streptococcal Pathophysiology Related to Septic Shock Management Destination: subsection.1.2 Item: Title: Objectives of This Study Destination: subsection.1.3 Item: Title: Results Destination: section.2 Children: Item: Title: General Management and Conventional Organ Support Destination: subsection.2.1 Item: Title: Personalized Treatment Destination: subsection.2.2 Children: Item: Title: Hyperinflammatory Phenotype Destination: subsubsection.2.2.1 Item: Title: Low Perfusion Phenotype Destination: subsubsection.2.2.2 Item: Title: Low Immunoglobulin Phenotype Destination: subsubsection.2.2.3 Item: Title: Discussion Destination: section.3 Children: Item: Title: Hyperinflammation with High Cytokine Phenotype Destination: subsection.3.1 Item: Title: Hyperinflammatory with High Endotoxemic Phenotype Destination: subsection.3.2 Item: Title: Sequential Approach Destination: subsection.3.3 Item: Title: Low Perfusion Phenotype Destination: subsection.3.4 Item: Title: Low Immunoglobulin Phenotype Destination: subsection.3.5 Item: Title: STSS and Its Relation to Precision Medicine Guided by Phenotypes Destination: subsection.3.6 Item: Title: Limitations Destination: subsection.3.7 Item: Title: Materials and Methods Destination: section.4 Children: Item: Title: Study Design and Setting, Inclusion Criteria and Analyzed Data and Scores Destination: subsection.4.1 Item: Title: Statistical Analysis Destination: subsection.4.2 Item: Title: Ethics Statement Destination: subsection.4.3 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Catastrophic Streptococcus pyogenes Disease: A Personalized Approach Based on Phenotypes and Treatable Traits Author: Juan Carlos Ruiz-Rodríguez, Luis Chiscano-Camón, Carolina Maldonado, Adolf Ruiz-Sanmartin, Laura Martin, Ivan Bajaña, Juliana Bastidas, Rocio Lopez-Martinez, Clara Franco-Jarava, Juan José González-López, Vicent Ribas, Nieves Larrosa, Jordi Riera, Xavier Nuvials-Casals and Ricard Ferrer Subject: Streptococcal toxic shock syndrome (STTS) is a critical medical emergency marked by high morbidity and mortality, necessitating swift awareness, targeted treatment, and early source control due to its rapid symptom manifestation. This report focuses on a cohort of 13 patients admitted to Vall d’Hebron University Hospital Intensive Care Unit, Barcelona, from November 2022 to March 2023, exhibiting invasive Streptococcus pyogenes infections and meeting institutional sepsis code activation criteria. The primary infections were community-acquired pneumonia (61.5%) and skin/soft tissue infection (30.8%). All patients received prompt antibiotic treatment, with clinical source control through thoracic drainage (30.8%) or surgical means (23.1%). Organ support involved invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy as per guidelines. Of note, 76.9% of patients experienced septic cardiomyopathy, and 53.8% required extracorporeal membrane oxygenation (ECMO). The study identified three distinct phenotypic profiles hyperinflammatory, low perfusion, and hypogammaglobulinemic which could guide personalized therapeutic approaches. STTS, with a mean SOFA score of 17 (5.7) and a 53.8% requiring ECMO, underscores the need for precision medicine-based rescue therapies and sepsis phenotype identification. Integrating these strategies with prompt antibiotics and efficient source control offers a potential avenue to mitigate organ failure, enhancing patient survival and recovery in the face of this severe clinical condition. 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