{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:00:26Z","timestamp":1791277226301,"version":"4.1.0"},"reference-count":84,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin\u20141 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease.<\/jats:p>","DOI":"10.3390\/antibiotics13010096","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T11:28:46Z","timestamp":1705577326000},"page":"96","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Toxic Shock Syndrome: A Literature Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Enora","family":"Atchade","sequence":"first","affiliation":[{"name":"DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"De Tymowski","sequence":"additional","affiliation":[{"name":"DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France"},{"name":"UFR Diderot, Paris Cit\u00e9 University, 75018 Paris, France"},{"name":"INSERM UMR 1149, Immunoreceptor and Renal Immunopathology, Bichat-Claude Bernard Hospital, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Grall","sequence":"additional","affiliation":[{"name":"UFR Diderot, Paris Cit\u00e9 University, 75018 Paris, France"},{"name":"Bacteriology Department, Bichat Claude Bernard Hospital, AP-HP, Paris Cit\u00e9 University, 75018 Paris, France"},{"name":"INSERM UMR 1137 Infection, Antimicrobials, Modelling, Evolution, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4698-3287","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Tanaka","sequence":"additional","affiliation":[{"name":"DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France"},{"name":"INSERM, UMR 1188, Diabetes Atherothrombosis R\u00e9union Oc\u00e9an Indien (D\u00e9TROI), la R\u00e9union University, 97400 Saint-Denis de la R\u00e9union, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3422-5705","authenticated-orcid":false,"given":"Philippe","family":"Montravers","sequence":"additional","affiliation":[{"name":"DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France"},{"name":"UFR Diderot, Paris Cit\u00e9 University, 75018 Paris, France"},{"name":"INSERM UMR 1152 ANR 10\u2014LABX-17, Pathophysiology and Epidemiology of Respiratory Diseases, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S1473-3099(09)70066-0","article-title":"Gram-positive toxic shock syndromes","volume":"9","author":"Lappin","year":"2009","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Armeftis, C., Ioannou, A., Lazarou, T., Giannopoulos, A., Dimitriadou, E., Makrides, K., and Pana, Z.D. (2023). Staphylococcus epidermidis induced toxic shock syndrome (TSS) secondary to influenza infection. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08487-3"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/978-1-4899-1825-3_27","article-title":"Mitogenic factors from group G streptococci associated with scarlet fever and streptococcal toxic shock syndrome","volume":"418","author":"Assimacopoulos","year":"1997","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1093\/clinids\/17.1.26","article-title":"Group B streptococcal toxic shock-like syndrome: Report of a case and purification of an associated pyrogenic toxin","volume":"17","author":"Schlievert","year":"1993","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1093\/clinids\/23.5.1159","article-title":"Acute group G streptococcal myositis associated with streptococcal toxic shock syndrome: Case report and review","volume":"23","author":"Wagner","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1046\/j.1469-0691.2002.00396.x","article-title":"Streptococcal toxic shock syndrome: A description of 14 cases from North Yorkshire, UK","volume":"8","author":"Barnham","year":"2002","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Pomputius, W.F., Kilgore, S.H., and Schlievert, P.M. (2023). Probable enterotoxin-associated toxic shock syndrome caused by Staphylococcus epidermidis. BMC Pediatr., 23.","DOI":"10.1186\/s12887-023-03914-5"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Goda, K., Kenzaka, T., Hoshijima, M., Yachie, A., and Akita, H. (2021). Toxic shock syndrome with a cytokine storm caused by Staphylococcus simulans: A case report. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-020-05731-y"},{"key":"ref_9","first-page":"e44604","article-title":"Clostridium sordellii: A Cause of Toxic Shock Syndrome after a Breach in the GI Tract","volume":"15","author":"Pence","year":"2023","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e242492","DOI":"10.1136\/bcr-2021-242492","article-title":"Clostridium perfringens of unclear origin causing pelvic inflammatory disease and toxic shock syndrome in a previously healthy young woman","volume":"14","author":"Covin","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.meegid.2013.03.013","article-title":"Staphylococcus aureus toxins\u2014Their functions and genetics","volume":"21","author":"Grumann","year":"2014","journal-title":"Infect. Genet. Evol."},{"key":"ref_12","first-page":"e2499","article-title":"Toxic Shock Syndrome after Surgery: Case Presentation and Systematic Review of the Literature","volume":"8","author":"Celie","year":"2020","journal-title":"Plast. Reconstr. Surg.-Glob. Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1128\/CMR.13.1.16","article-title":"Exotoxins of Staphylococcus aureus","volume":"13","author":"Dinges","year":"2000","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/S0140-6736(78)92274-2","article-title":"Toxic-shock syndrome associated with phage-group-I Staphylococci","volume":"2","author":"Todd","year":"1978","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1056\/NEJM198012183032501","article-title":"Toxic-shock syndrome: Epidemiologic features, recurrence, risk factors, and prevention","volume":"303","author":"Davis","year":"1980","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e313","DOI":"10.1016\/S1473-3099(19)30041-6","article-title":"Menstrual toxic shock syndrome: Case report and systematic review of the literature","volume":"19","author":"Berger","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1016\/S0163-4453(17)30206-2","article-title":"Toxic shock syndrome\u2014The seven Rs of management and treatment","volume":"74","author":"Wilkins","year":"2017","journal-title":"J. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1093\/cid\/ciab378","article-title":"Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study","volume":"74","author":"Contou","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3201\/eid2402.170606","article-title":"Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom","volume":"24","author":"Sharma","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.mm6354a1","article-title":"Summary of Notifiable Infectious Diseases and Conditions\u2013United States, 2014","volume":"63","author":"Adams","year":"2016","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1093\/infdis\/145.4.458","article-title":"Toxic-shock syndrome in minnesota: Results of an active-passive surveillance system","volume":"145","author":"Osterholm","year":"1982","journal-title":"J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3201\/eid0506.990611","article-title":"Toxic Shock Syndrome in the United States: Surveillance Update, 1979\u20131996","volume":"5","author":"Hajjeh","year":"1999","journal-title":"Emerg. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"DeVries, A.S., Lesher, L., Schlievert, P.M., Rogers, T., Villaume, L.G., Danila, R., and Lynfield, R. (2011). Staphylococcal toxic shock syndrome 2000\u20132006: Epidemiology, clinical features, and molecular characteristics. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0022997"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2704","DOI":"10.1128\/JCM.02295-06","article-title":"Vaginal Staphylococcus aureus superantigen profile shift from 1980 and 1981 to 2003, 2004, and 2005","volume":"45","author":"Schlievert","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e00032-19","DOI":"10.1128\/CMR.00032-19","article-title":"Device-Associated Menstrual Toxic Shock Syndrome","volume":"33","author":"Schlievert","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1093\/infdis\/151.5.883","article-title":"Development of Serum Antibody to Toxic Shock Toxin among Individuals with Toxic Shock Syndrome in Wisconsin","volume":"151","author":"Stolz","year":"1985","journal-title":"J. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e01171","DOI":"10.1016\/j.idcr.2021.e01171","article-title":"Toxic shock syndrome associated with menstrual cup use","volume":"25","author":"Bagheri","year":"2021","journal-title":"IDCases"},{"key":"ref_28","first-page":"001825","article-title":"Menstrual Cup-Associated Toxic Shock Syndrome","volume":"7","author":"Neumann","year":"2020","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1155\/2015\/560959","article-title":"A confirmed case of toxic shock syndrome associated with the use of a menstrual cup","volume":"26","author":"Mitchell","year":"2015","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.annemergmed.2009.05.030","article-title":"Fatal Toxic Shock Syndrome from an Intrauterine Device","volume":"54","author":"Klug","year":"2009","journal-title":"Ann. Emerg. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s10096-007-0405-2","article-title":"One in five mortality in non-menstrual toxic shock syndrome versus no mortality in menstrual cases in a balanced French series of 55 cases","volume":"27","author":"Descloux","year":"2008","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Truant, S.N., Redolfi, D.M., Sarratea, M.B., Malchiodi, E.L., and Fern\u00e1ndez, M.M. (2022). Superantigens, a Paradox of the Immune Response. Toxins, 14.","DOI":"10.3390\/toxins14110800"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3109\/10408419009105728","article-title":"Staphylococcal and Streptococcal Pyrogenic Toxins Involved in Toxic Shock Syndrome and Related Illnesses","volume":"17","author":"Bohach","year":"1990","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1128\/iai.57.1.231-234.1989","article-title":"Determination by western blot (immunoblot) of seroconversions to toxic shock syndrome (TSS) toxin 1 and enterotoxin A, B, or C during infection with TSS- and non-TSS-associated Staphylococcus aureus","volume":"57","author":"Whiting","year":"1989","journal-title":"Infect. Immun."},{"key":"ref_35","first-page":"2670179","article-title":"Postpartum Methicillin-Resistant Staphylococcus aureus Toxic Shock Syndrome Caused by a Perineal Infection","volume":"2018","author":"Deguchi","year":"2018","journal-title":"Case Rep. Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1097\/AOG.0b013e3181866468","article-title":"Nonmenstrual Toxic Shock Syndrome Due to Methicillin-Resistant Staphylococcus aureus","volume":"112","author":"Andrews","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ejogrb.2009.02.040","article-title":"Postpartum toxic shock syndrome due to methicillin-resistant Staphylococcus aureus epidemic in community","volume":"144","author":"Collet","year":"2009","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"507","DOI":"10.3389\/fimmu.2013.00507","article-title":"Staphylococcus aureus Colonization: Modulation of Host Immune Response and Impact on Human Vaccine Design","volume":"4","author":"Brown","year":"2014","journal-title":"Front. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sakr, A., Br\u00e9geon, F., M\u00e8ge, J.-L., Rolain, J.-M., and Blin, O. (2018). Staphylococcus aureus Nasal Colonization: An Update on Mechanisms, Epidemiology, Risk Factors, and Subsequent Infections. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.02419"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e2339793","DOI":"10.1001\/jamanetworkopen.2023.39793","article-title":"Postoperative Staphylococcus aureus Infections in Patients with and without Preoperative Colonization","volume":"6","author":"Troeman","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jgar.2023.06.001","article-title":"Molecular characterization and antimicrobial resistance of nasal Staphylococcus aureus in the community of Kabul","volume":"34","author":"Naimi","year":"2023","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1056\/NEJM198707163170305","article-title":"Clinical and Bacteriologic Observations of a Toxic Shock\u2013like Syndrome Due to Streptococcus pyogenes","volume":"317","author":"Cone","year":"1987","journal-title":"N. Engl. J. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM198907063210101","article-title":"Severe Group A Streptococcal Infections Associated with a Toxic Shock-like Syndrome and Scarlet Fever Toxin A","volume":"321","author":"Stevens","year":"1989","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1001\/jama.1993.03500030088038","article-title":"Defining the Group A Streptococcal Toxic Shock Syndrome: Rationale and Consensus Definition","volume":"269","author":"Breiman","year":"1993","journal-title":"JAMA"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1111\/j.1469-0691.2011.03624.x","article-title":"Invasive group A streptococcal infections in adults, France (2006\u20132010)","volume":"18","author":"Plainvert","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"202","DOI":"10.3201\/eid1402.070888","article-title":"Severe Streptococcus pyogenes Infections, United Kingdom, 2003\u20132004","volume":"14","author":"Lamagni","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1128\/JCM.00422-08","article-title":"Epidemiology of Severe Streptococcus pyogenes Disease in Europe","volume":"46","author":"Lamagni","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"4094","DOI":"10.1128\/JCM.00070-11","article-title":"Epidemiology of InvasiveStreptococcus pyogenesInfections in France in 2007","volume":"49","author":"Lepoutre","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1046\/j.1469-0691.2002.00387.x","article-title":"Streptococcal toxic shock syndrome","volume":"8","author":"Stevens","year":"2002","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e00352","DOI":"10.1016\/j.crwh.2021.e00352","article-title":"Streptococcal toxic shock syndrome in the setting of recent gynecologic surgery: A case report","volume":"32","author":"Gruttadauria","year":"2021","journal-title":"Case Rep. Women\u2019s Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1111\/j.1365-2230.2007.02652.x","article-title":"Severe necrotizing soft-tissue infections and nonsteroidal anti-inflammatory drugs","volume":"33","author":"Souyri","year":"2008","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1086\/593016","article-title":"Muscle injury, vimentin expression, and nonsteroidal anti-inflammatory drugs predispose to cryptic group A streptococcal necrotizing infection","volume":"198","author":"Hamilton","year":"2008","journal-title":"J. Infect. Dis."},{"key":"ref_53","first-page":"105","article-title":"Induction of cytokines in human peripheral blood and spleen cells by the Mycoplasma arthritidis-derived superantigen","volume":"11","author":"Rink","year":"1992","journal-title":"Lymphokine Cytokine Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e572","DOI":"10.1111\/j.1365-2567.2008.03033.x","article-title":"Superantigen-presentation by rat major histocompatibility complex class II molecules RT1.Bl and RT1.Dl","volume":"128","author":"Dlaske","year":"2009","journal-title":"Immunology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1128\/jcm.25.10.2028-2029.1987","article-title":"Evaluation of coagulase-negative staphylococci for ability to produce toxic shock syndrome toxin 1","volume":"25","author":"Kreiswirth","year":"1987","journal-title":"J. Clin. Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1128\/JB.00162-10","article-title":"An Enterotoxin-Bearing Pathogenicity Island in Staphylococcus epidermidis","volume":"193","author":"Madhusoodanan","year":"2011","journal-title":"J. Bacteriol."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Stach, C.S., Vu, B.G., and Schlievert, P.M. (2015). Determining the Presence of Superantigens in Coagulase Negative Staphylococci from Humans. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143341"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1128\/jcm.23.1.43-45.1986","article-title":"Involvement of coagulase-negative staphylococci in toxic shock syndrome","volume":"23","author":"Crass","year":"1986","journal-title":"J. Clin. Microbiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1574-695X.1996.tb00219.x","article-title":"Coagulase-negative staphylococci isolated from two cases of toxic shock syndrome lack superantigenic activity, but induce cytokine production","volume":"13","author":"Lina","year":"1996","journal-title":"FEMS Immunol. Med. Microbiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13017-022-00406-2","article-title":"WSES\/GAIS\/WSIS\/SIS-E\/AAST global clinical pathways for patients with skin and soft tissue infections","volume":"17","author":"Sartelli","year":"2022","journal-title":"World J. Emerg. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"609497","DOI":"10.3389\/fmed.2020.609497","article-title":"Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients","volume":"7","author":"Thy","year":"2020","journal-title":"Front. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s10096-021-04354-8","article-title":"Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: Results from a French retrospective and observational study","volume":"41","author":"Tanaka","year":"2022","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1089\/sur.2021.256","article-title":"Evaluation of Antibiotic Duration after Surgical Debridement of Necrotizing Soft Tissue Infection","volume":"23","author":"Kenneally","year":"2022","journal-title":"Surg. Infect."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1089\/sur.2022.011","article-title":"Duration of Antibiotic Therapy in Necrotizing Soft Tissue Infections: Shorter is Safe","volume":"23","author":"Terzian","year":"2022","journal-title":"Surg. Infect."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1177\/00031348211051700","article-title":"Short Courses of Antibiotics Are Safe in Necrotizing Soft Tissue Infections","volume":"87","author":"Valadez","year":"2021","journal-title":"Am. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1128\/AAC.47.5.1752-1755.2003","article-title":"Influences of Linezolid, Penicillin, and Clindamycin, Alone and in Combination, on Streptococcal Pyrogenic Exotoxin A Release","volume":"47","author":"Coyle","year":"2003","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/cid\/ciu304","article-title":"Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group a streptococcal infections","volume":"59","author":"Carapetis","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1093\/cid\/ciu449","article-title":"Clinical Efficacy of Polyspecific Intravenous Immunoglobulin Therapy in Patients with Streptococcal Toxic Shock Syndrome: A Comparative Observational Study","volume":"59","author":"Linner","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S1473-3099(20)30523-5","article-title":"Effectiveness of adjunctive clindamycin in \u03b2-lactam antibiotic-treated patients with invasive \u03b2-haemolytic streptococcal infections in US hospitals: A retrospective multicentre cohort study","volume":"21","author":"Babiker","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"ofad258","DOI":"10.1093\/ofid\/ofad258","article-title":"Clindamycin plus Vancomycin versus Linezolid for Treatment of Necrotizing Soft Tissue Infection","volume":"10","author":"Dorazio","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"350","DOI":"10.4269\/ajtmh.22-0492","article-title":"A Multicenter Experience of Inducible Clindamycin Resistance in Staphylococcus aureus Infection among 800 Egyptian Patients with or without Diabetes Mellitus","volume":"109","author":"Helmy","year":"2023","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1086\/500265","article-title":"Successful Treatment of Staphylococcal Toxic Shock Syndrome with Linezolid: A Case Report and In Vitro Evaluation of the Production of Toxic Shock Syndrome Toxin Type 1 in the Presence of Antibiotics","volume":"42","author":"Stevens","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1172\/JCI116240","article-title":"Intravenous immunoglobulin contains specific antibodies inhibitory to activation of T cells by staphylococcal toxin superantigens [see comment]","volume":"91","author":"Takei","year":"1993","journal-title":"J. Clin. Investig."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3057","DOI":"10.4049\/jimmunol.156.8.3057","article-title":"Plasma from patients with severe invasive group A streptococcal infections treated with normal polyspecific IgG inhibits streptococcal superantigen-induced T cell proliferation and cytokine production","volume":"156","author":"Kaul","year":"1996","journal-title":"J. Immunol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1086\/376630","article-title":"The Streptlg Study Group Intravenous Immunoglobulin G Therapy in Streptococcal Toxic Shock Syndrome: A European Randomized, Double-Blind, Placebo-Controlled Trial","volume":"37","author":"Darenberg","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1007\/s00134-017-4786-0","article-title":"Immunoglobulin G for patients with necrotising soft tissue infection (INSTINCT): A randomised, blinded, placebo-controlled trial","volume":"43","author":"Madsen","year":"2017","journal-title":"Intensiv. Care Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1093\/cid\/ciy401","article-title":"Polyspecific Intravenous Immunoglobulin in Clindamycin-treated Patients with Streptococcal Toxic Shock Syndrome: A Systematic Review and Meta-analysis","volume":"67","author":"Parks","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e063023","DOI":"10.1136\/bmjopen-2022-063023","article-title":"Prognostic factors for streptococcal toxic shock syndrome: Systematic review and meta-analysis","volume":"12","author":"Bartoszko","year":"2022","journal-title":"BMJ Open"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ijid.2023.08.011","article-title":"Effectiveness of intravenous immunoglobulin therapy for invasive group A Streptococcus infection: A Japanese nationwide observational study","volume":"135","author":"Senda","year":"2023","journal-title":"Int. J. Infect. Dis."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1056\/NEJM199608223350803","article-title":"Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group","volume":"335","author":"Davies","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1086\/521264","article-title":"The Epidemiology of Invasive Group A Streptococcal Infection and Potential Vaccine Implications: United States, 2000\u20132004","volume":"45","author":"Roberson","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Schlievert, P.M., Gait\u00e1n, A.V., Kilgore, S.H., Roe, A.L., Maukonen, J., Lehtoranta, L., Leung, D.Y.M., and Marsman, D.S. (2023). Inhibition of Toxic Shock Syndrome-Associated Staphylococcus aureus by Probiotic Lactobacilli. Microbiol. Spectr., 11.","DOI":"10.1128\/spectrum.01735-23"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/S1473-3099(16)30115-3","article-title":"Safety, tolerability, and immunogenicity of a recombinant toxic shock syndrome toxin (rTSST)-1 variant vaccine: A randomised, double-blind, adjuvant-controlled, dose escalation first-in-man trial","volume":"16","author":"Schwameis","year":"2016","journal-title":"Lancet Infect. Dis."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/96\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:49:48Z","timestamp":1760104188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/96"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":84,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["antibiotics13010096"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13010096","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,18]]}}}