{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:23:14Z","timestamp":1793812994366,"version":"4.6.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>After the COVID-19 pandemic an increase in Group A streptococcal (GAS) infections was reported mostly for children in several countries worldwide. However, data on infections in adults remain limited. Therefore, we focus on the pre- and post-pandemic incidence of GAS infections in adults, the need for intensive care treatment and the microbiological sampling patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of hospitalized adult patients from 2012 to 2024, based on a positive GAS detection in their routine microbiological sampling. We compared the post-pandemic phase after lifting the isolation measures in April 2022 to the pandemic and pre-pandemic phase. Additionally, we analysed positive rapid assessment tests in children, indicative of the prevalence of GAS tonsillitis in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the post-pandemic months, we observed a significant increase in overall hospitalized adult patients (IRR 2.94) and ICU patients (IRR 2.5) with GAS infections. The rise can be attributed to an increase in both invasive and non-invasive GAS detections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The increase in GAS infections is not only relevant in paediatric patients, but also has significant relevance in adult patients. Physicians need to be aware of this increase. The data of 2024 show a sustained increase and an incidence that has not returned to pre-pandemic levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-025-02668-9","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:53:11Z","timestamp":1761922391000},"page":"503-508","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Post-pandemic increase of Group A streptococcal infections in adults: a retrospective cohort study from 2012 to 2024"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0570-5902","authenticated-orcid":false,"given":"Anne Kathrin","family":"L\u00f6sslein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5885-6029","authenticated-orcid":false,"given":"Tessa","family":"Goerne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2209-4154","authenticated-orcid":false,"given":"Roland","family":"Elling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3659-0407","authenticated-orcid":false,"given":"Tobias","family":"Wengenmayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1058-5746","authenticated-orcid":false,"given":"Georg","family":"H\u00e4cker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3470-5936","authenticated-orcid":false,"given":"Paul Marc","family":"Biever","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"2668_CR1","doi-asserted-by":"publisher","first-page":"e70078","DOI":"10.1111\/irv.70078","volume":"19","author":"A Gentile","year":"2025","unstructured":"Gentile A, Ju\u00e1rez M, del Ensinck V, Lopez G, Melonari O, Fern\u00e1ndez P. Comparative analysis of influenza epidemiology before and after the COVID-19 pandemic in Argentina (2018\u20132019 vs. 2022\u20132023). Influenza Other Respir Viruses. 2025;19:e70078. https:\/\/doi.org\/10.1111\/irv.70078.","journal-title":"Influenza Other Respir Viruses"},{"key":"2668_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-023-02085-w","author":"N Maison","year":"2023","unstructured":"Maison N, Omony J, Rinderknecht S, Kolberg L, Meyer-B\u00fchn M, von Mutius E, et al. Old foes following news ways?\u2014Pandemic-related changes in the epidemiology of viral respiratory tract infections. Infection. 2023. https:\/\/doi.org\/10.1007\/s15010-023-02085-w.","journal-title":"Infection"},{"key":"2668_CR3","unstructured":"Geneva. World Health Organization. Global tuberculosis report 2024. 2024. Licence: CC BY-NC-SA 3.0 IGO."},{"key":"2668_CR4","doi-asserted-by":"publisher","first-page":"e100","DOI":"10.1016\/S2666-5247(23)00344-0","volume":"5","author":"PMM Sauteur","year":"2024","unstructured":"Sauteur PMM, Beeton ML, Pereyre S, B\u00e9b\u00e9ar C, Gardette M, H\u00e9nin N, et al. Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions. Lancet Microbe. 2024;5:e100\u20131. https:\/\/doi.org\/10.1016\/S2666-5247(23)00344-0.","journal-title":"Lancet Microbe"},{"key":"2668_CR5","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1038\/s41579-023-00865-7","volume":"21","author":"S Brouwer","year":"2023","unstructured":"Brouwer S, Rivera-Hernandez T, Curren BF, Harbison-Price N, De Oliveira DMP, Jespersen MG, et al. Pathogenesis, epidemiology and control of group A Streptococcus infection. Nat Rev Microbiol. 2023;21:431\u201347. https:\/\/doi.org\/10.1038\/s41579-023-00865-7.","journal-title":"Nat Rev Microbiol"},{"key":"2668_CR6","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1097\/JS9.0000000000000232","volume":"109","author":"RK Mohapatra","year":"2023","unstructured":"Mohapatra RK, Kutikuppala LVS, Mishra S, Tuglo LS, Dhama K. Rising global incidence of invasive group A Streptococcus infection and Scarlet fever in the COVID-19 era \u2013 our knowledge thus Far. Int J Surg. 2023;109:639\u201340. https:\/\/doi.org\/10.1097\/JS9.0000000000000232.","journal-title":"Int J Surg"},{"key":"2668_CR7","doi-asserted-by":"publisher","first-page":"2200941","DOI":"10.2807\/1560-7917.ES.2023.28.1.2200941","volume":"28","author":"B de Gier","year":"2023","unstructured":"de Gier B, Marchal N, de Beer-Schuurman I, Te Wierik M, Hooiveld M, Study Group ISIS-AR, et al. Increase in invasive group A Streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022. Euro Surveill. 2023;28:2200941. https:\/\/doi.org\/10.2807\/1560-7917.ES.2023.28.1.2200941.","journal-title":"Euro Surveill"},{"key":"2668_CR8","doi-asserted-by":"publisher","unstructured":"Holdstock V, Heppenstall E, Corrigan D, Eccleston A, Jones L, Kalima P, et al. National 10-year cohort study of Life-threatening invasive group A Streptococcal infection in Children, 2013\u20132023. Pediatr Infect Dis J. n.d. https:\/\/doi.org\/10.1097\/INF.0000000000004855. https:\/\/doi.org\/10.1097\/INF.0000000000004855.","DOI":"10.1097\/INF.0000000000004855"},{"key":"2668_CR9","doi-asserted-by":"publisher","first-page":"199","DOI":"10.3390\/pathogens14020199","volume":"14","author":"P Le\u015bnik","year":"2025","unstructured":"Le\u015bnik P, Janc J, Bia\u0142a M, Bartoszewicz M, \u0141ysenko L, S\u0142abisz N. Old Bug-New challenges after COVID-19 pandemic: severe invasive Streptococcus pyogenes infections in Adults-A Single-Center experience in Poland. Pathogens. 2025;14:199. https:\/\/doi.org\/10.3390\/pathogens14020199.","journal-title":"Pathogens"},{"key":"2668_CR10","doi-asserted-by":"publisher","unstructured":"Mutevelli J, Singer R, D\u00f6rre A, Feig M, Noll I, Eckmanns T et al. Epidemiologie der Gruppe-A-Streptokokken in Deutschland, 2023\u20132024 2024. https:\/\/doi.org\/10.25646\/12000","DOI":"10.25646\/12000"},{"key":"2668_CR11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13054-023-04774-2","volume":"28","author":"A Orieux","year":"2024","unstructured":"Orieux A, Prevel R, Dumery M, Lascarrou J-B, Zucman N, Reizine F, et al. Invasive group A Streptococcal infections requiring admission to ICU: a nationwide, multicenter, retrospective study (ISTRE study). Crit Care. 2024;28:4. https:\/\/doi.org\/10.1186\/s13054-023-04774-2.","journal-title":"Crit Care"},{"key":"2668_CR12","doi-asserted-by":"publisher","first-page":"102622","DOI":"10.1016\/j.jiph.2024.102622","volume":"18","author":"A Mania","year":"2025","unstructured":"Mania A, Mazur-Melewska K, Witczak C, Cwali\u0144ska A, Ma\u0142ecki P, Meissner A, et al. Invasive group A Streptococcal infections as a consequence of coexisting or previous viral infection in the post-COVID-19 pandemic period. J Infect Public Health. 2025;18:102622. https:\/\/doi.org\/10.1016\/j.jiph.2024.102622.","journal-title":"J Infect Public Health"},{"key":"2668_CR13","doi-asserted-by":"publisher","first-page":"100873","DOI":"10.1016\/j.lanwpc.2023.100873","volume":"41","author":"Y-N Abo","year":"2023","unstructured":"Abo Y-N, Oliver J, McMinn A, Osowicki J, Baker C, Clark JE, et al. Increase in invasive group A Streptococcal disease among Australian children coinciding with Northern hemisphere surges. Lancet Reg Health West Pac. 2023;41:100873. https:\/\/doi.org\/10.1016\/j.lanwpc.2023.100873.","journal-title":"Lancet Reg Health West Pac"},{"key":"2668_CR14","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3201\/eid3102.240880","volume":"31","author":"MA Davies","year":"2025","unstructured":"Davies MA, de Gier B, Guy RL, Coelho J, van Dam AP, van Houdt R, et al. Streptococcus pyogenes Emm type 3.93 Emergence, the Netherlands and England. Emerg Infect Dis. 2025;31:229\u201336. https:\/\/doi.org\/10.3201\/eid3102.240880.","journal-title":"Emerg Infect Dis"},{"key":"2668_CR15","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/s15010-023-02137-1","volume":"52","author":"M Wolters","year":"2024","unstructured":"Wolters M, Berinson B, Degel-Brossmann N, Hoffmann A, Bluszis R, Aepfelbacher M, et al. Population of invasive group A Streptococci isolates from a German tertiary care center is dominated by the hypertoxigenic virulent M1UK genotype. Infection. 2024;52:667\u201371. https:\/\/doi.org\/10.1007\/s15010-023-02137-1.","journal-title":"Infection"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-025-02668-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-025-02668-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-025-02668-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T08:39:52Z","timestamp":1770021592000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-025-02668-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["2668"],"URL":"https:\/\/doi.org\/10.1007\/s15010-025-02668-9","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"assertion":[{"value":"3 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research project was approved by the Ethics Committee of the University of Freiburg (24-1116-S1-retro and 24-1116_1-S1-retro) on 21st May 2024 and 11th February 2025. The retrospective study was registered in the German Clinical Trials Register (DRKS00033853) and the International Clinical Trials Registry Platform of the WHO.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Patient consent was waived after approval by the ethics committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no conflicts of interest. TW received honoraria for presentations from AstraZeneca, Boston Scientific, Abbott Medical.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}