ArticleJCI insight2016
Biofilm in group A streptococcal necrotizing soft tissue infections.
Article in JCI insight, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
49 citing papers in PubMed, 1 synthesis or guideline pooled it, 87 citations in OpenAlex.
- Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis.Diving and hyperbaric medicine · 2021Pooled it
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- A validated model for early prediction of group A streptococcal aetiology in necrotising soft tissue infections using minimal patient data.BMC medicine · 2026Article
- <italic>Streptococcus pyogenes</italic> Infection and CD4Journal of innate immunity · 2026Article
- Structural basis for collagen recognition by theeLife · 2025Article
- Pentamidine inhibition of streptopain attenuatesMicrobiology spectrum · 2025Article
- Pentamidine inhibition of streptopain attenuatesbioRxiv : the preprint server for biology · 2025Article
- Global spread of Streptococcus pyogenes A genomics-supported narrative review.FEMS microbiology reviews · 2025Review
- The intricate pathogenicity of Group AVirulence · 2024Review
- Nosocomial Transmission of Necrotizing Fasciitis: A Molecular Characterization of Group A Streptococcal DNases in Clinical Virulence.Microorganisms · 2024Article
- Inhibition ofmSphere · 2024Article
- Streptokinase reduces Streptococcus dysgalactiae subsp. equisimilis biofilm formation.BMC microbiology · 2024Article
- Investigating group AmSphere · 2024Article
- Group A Streptococcus Pili-Roles in Pathogenesis and Potential for Vaccine Development.Microorganisms · 2024Review
- Reduced interleukin-18 secretion by human monocytic cells in response to infections with hyper-virulent Streptococcus pyogenes.Journal of biomedical science · 2024Article
- HLA-II-Dependent Neuroimmune Changes in Group A Streptococcal Necrotizing Fasciitis.Pathogens (Basel, Switzerland) · 2023Article
- Neutrophil-derived reactive agents induce a transient SpeB negative phenotype in Streptococcus pyogenes.Journal of biomedical science · 2023Article
- Architecture and matrix assembly determinants of Bordetella pertussis biofilms on primary human airway epithelium.PLoS pathogens · 2023Article
- Article
Corrections and comments
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Authors and funding
16 authors at 5 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign devices. Here, we present a case of a previously healthy male presenting with NSTI caused by GAS. The infection persisted over 24 days, and the surgeon documented the presence of a "thick layer biofilm" in the fascia. Subsequent analysis of NSTI patient tissue biopsies prospectively included in a multicenter study revealed multiple areas of biofilm in 32% of the patients studied. Biopsies associated with biofilm formation were characterized by massive bacterial load, a pronounced inflammatory response, and clinical signs of more severe tissue involvement. In vitro infections of a human skin tissue model with GAS NSTI isolates also revealed multilayered fibrous biofilm structures, which were found to be under the control of the global Nra gene regulator. The finding of GAS biofilm formation in NSTIs emphasizes the urgent need for biofilm to be considered as a potential complicating microbiological feature of GAS NSTI and, consequently, emphasizes reconsideration of antibiotic treatment protocols.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.