Impact of comorbidity burden and skin integrity on clinical presentation and outcomes in Streptococcus dysgalactiae subspecies equisimilis bacteremia

The purpose of this study was to evaluate the impact of comorbidity burden on clinical presentation and mortality in Streptococcus dysgalactiae subspecies equisimilis (SDSE) bacteremia, and to assess the association between disruption of the cutaneous barrier and clinical manifestation. We conducted a prospective study of 159 episodes of SDSE bacteremia in 157 adult patients in Finland between 2015 and 2019. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI). 30-day mortality and clinical manifestation of SDSE bacteremia were analyzed in relation to comorbidity burden. Disruption of the cutaneous barrier was examined in relation to the presenting clinical manifestation. Higher comorbidity burden was associated with mortality; a CCI ≥ 4 increased the risk of death fourfold (p = 0.035). Cerebral infarction, chronic pulmonary disease—particularly chronic obstructive pulmonary disease—and leukemia were independently associated with mortality. The 30-day mortality was 6%. Cellulitis was more common among patients with a lower comorbidity burden, whereas bacteremia without a defined focus predominated in patients with higher comorbidity burden. Disruption of the cutaneous barrier was associated with skin and soft tissue infections, while endocarditis, bone and joint infections, and bacteremia without a defined focus were more frequent among patients with intact skin. Comorbidity burden and skin integrity appear to be relevant factors in determining the clinical presentation and prognosis of SDSE bacteremia. These findings suggest that comorbidity assessment and skin evaluation may be useful for understanding the clinical presentation and prognosis of SDSE bacteremia.