Surveillance of invasive beta-haemolytic streptococci in Denmark, 2012 to 2023: A nationwide study

Abstract

Objectives

To analyse trends in incidence, seasonality, and antimicrobial resistance of invasive beta-haemolytic streptococci (iBHS) in Denmark from 2012 to 2023.

Methods

Nationwide laboratory surveillance included submission of invasive isolates of Lancefield group A, B, C, and G streptococci from blood, cerebrospinal fluid, and other sterile sites to the National Reference Laboratory. Incidence rates (IRs) per 100,000 were calculated. Seasonality was analysed using Poisson regression, and antimicrobial susceptibility was determined by EUCAST disc diffusion.

Results

In total, 9470 iBHS cases were identified. Annual IRs increased from 2.6 to 9.4 for iGAS, 2.5 to 4.9 for iGBS, 1.4 to 4.8 for iGCS, and 3.1 to 8.5 for iGGS. iGAS exhibited marked seasonality, peaking in February and troughing in September (peak-to-trough ratio 3.2). Incidence declined during the COVID-19 pandemic but rebounded in 2023. No seasonality was observed for iGBS, iGCS, or iGGS. Incidences were highest in males and older adults, except iGBS, which showed a bimodal distribution. Recurrent infections occurred in 5.4% of cases, predominantly with iGGS and iGCS. All isolates were penicillin susceptible, but erythromycin and clindamycin resistance increased in iGBS and iGGS.

Conclusions

The rising incidence of iBHS, particularly iGAS resurgence and increasing resistance, highlights the need for continued surveillance.