{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:45:34Z","timestamp":1793447134768,"version":"4.5.0"},"reference-count":59,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T00:00:00Z","timestamp":1707955200000},"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>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\u2019Hebron 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\u2014hyperinflammatory, low perfusion, and hypogammaglobulinemic\u2014which 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.<\/jats:p>","DOI":"10.3390\/antibiotics13020187","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T05:55:59Z","timestamp":1707976559000},"page":"187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Catastrophic Streptococcus pyogenes Disease: A Personalized Approach Based on Phenotypes and Treatable Traits"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7392-8617","authenticated-orcid":false,"given":"Juan Carlos","family":"Ruiz-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Intensive Care Department, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation Research Group, Vall d\u2019Hebron Research Institute (VHIR), Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Departament of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0037-0610","authenticated-orcid":false,"given":"Luis","family":"Chiscano-Cam\u00f3n","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation Research Group, Vall d\u2019Hebron Research Institute (VHIR), Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Departament of Medicine, Universitat Autonoma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation Research Group, Vall d\u2019Hebron Research Institute (VHIR), Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolf","family":"Ruiz-Sanmartin","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation Research Group, Vall d\u2019Hebron Research Institute (VHIR), Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital 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Hospital Campus, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Bastidas","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"},{"name":"Shock, Organ Dysfunction and Resuscitation Research Group, Vall d\u2019Hebron Research Institute (VHIR), Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocio","family":"Lopez-Martinez","sequence":"additional","affiliation":[{"name":"Immunology Department, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Franco-Jarava","sequence":"additional","affiliation":[{"name":"Immunology Department, Vall 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Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S1473-3099(23)00008-7","article-title":"National case series of group A streptococcus pleural empyema in children: Clinical and microbiological features","volume":"23","author":"Holdstock","year":"2023","journal-title":"Lancet Infect. 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