{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:58:59Z","timestamp":1760821139764,"version":"3.41.2"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,5,31]],"date-time":"2020-05-31T00:00:00Z","timestamp":1590883200000},"content-version":"vor","delay-in-days":151,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp; Surgery"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Combined detailed analysis of patient characteristics and treatment as well as bacterial virulence factors, which all play a central role in the cause of infections leading to severe illness, has not been reported. We aimed to describe the patient characteristics (Charlson comorbidity index [CCI]), treatment (3\u2010h bundle), and outcomes in relation to bacterial virulence of <jats:italic>Streptococcus pneumoniae<\/jats:italic> and beta\u2010hemolytic <jats:italic>Streptococcus<\/jats:italic> (BHS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This sepsis primary study is part of the larger Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study, a multicenter, prospective cohort study. We included patients diagnosed with <jats:italic>S.\u00a0pneumoniae<\/jats:italic> and BHS sepsis and examined virulence, defining the high\u2010virulence factor as follows: <jats:italic>S.\u00a0pneumoniae<\/jats:italic> serotype 3, 31, 11A, 35F, and 17F; <jats:italic>Streptococcus pyogenes<\/jats:italic>, <jats:italic>emm 1<\/jats:italic>; <jats:italic>Streptococcus agalactiae<\/jats:italic>, III; and <jats:italic>Streptococcus dysgalactiae ssp. equisimilis<\/jats:italic>, <jats:italic>emm<\/jats:italic> typing pattern <jats:italic>stG 6792<\/jats:italic>. Included patients were divided into high and normal categories based on the virulence factor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1,184 sepsis patients enrolled in the Japanese Association for Acute Medicine\u2019s FORECAST study, 62 were included in the current study (29 cases with <jats:italic>S.\u00a0pneumoniae<\/jats:italic> sepsis and 33 with BHS). The CCI and completion of a 3\u2010h bundle did not differ between normal and high virulence groups. Risk of 28\u2010day mortality was significantly higher for high\u2010virulence compared to normal\u2010virulence when adjusted for CCI and completion of a 3\u2010h bundle (Cox proportional hazards regression analysis, hazard ratio 3.848; 95% confidence interval, 1.108\u201313.370; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.034).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The risk of 28\u2010day mortality was significantly higher for patients with high\u2010virulence compared to normal\u2010virulence bacteria.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ams2.513","type":"journal-article","created":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T07:12:37Z","timestamp":1590995557000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical characteristics of patients with severe sepsis and septic shock in relation to bacterial virulence of beta\u2010hemolytic <i>Streptococcus<\/i> and <i>Streptococcus pneumoniae<\/i>"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3581-0890","authenticated-orcid":false,"given":"Toru","family":"Hifumi","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine St. Luke\u2019s International Hospital Emergency Medical Center Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8823-8440","authenticated-orcid":false,"given":"Seitaro","family":"Fujishima","sequence":"additional","affiliation":[{"name":"Center for General Medicine Education School of Medicine Keio University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimiko","family":"Ubukata","sequence":"additional","affiliation":[{"name":"Center for General Medicine Education School of Medicine Keio University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0012-5180","authenticated-orcid":false,"given":"Akiyoshi","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Emergency Medicine  Center Hospital of the National Center for Global Health and Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshikazu","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of General Medicine Juntendo University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Ogura","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Shiraishi","sequence":"additional","affiliation":[{"name":"Emergency Department Kameda Medical Center Kamogawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9232-5782","authenticated-orcid":false,"given":"Shigeki","family":"Kushimoto","sequence":"additional","affiliation":[{"name":"Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daizoh","family":"Saitoh","sequence":"additional","affiliation":[{"name":"Division of Traumatology Research Institute National Defense Medical College Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshihiko","family":"Mayumi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine School of Medicine University of Occupational and Environmental Health Kitakyushu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroto","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Ueyama","sequence":"additional","affiliation":[{"name":"Department of Trauma Critical Care Medicine, and Burn Center Japan Community Healthcare Organization, Chukyo Hospital Nagoya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiro","family":"Otomo","sequence":"additional","affiliation":[{"name":"Trauma and Acute Critical Care Medical Center Medical Hospital Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kohji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Kitakyushu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Umemura","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joji","family":"Kotani","sequence":"additional","affiliation":[{"name":"Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichiro","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Medicine Saga University Hospital Saga Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasukazu","family":"Shiino","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine Kawasaki Medical School Kurashiki 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