The increased prevalence of severe necrotizing infections caused by non-group A streptococci

The authors report on 20 patients who were admitted to the University of Te xas Health Science Center at San Antonio during a recent 4-month period wit h foot infections caused predominantly by non-group A streptococci. This nu mber of patients was significantly greater than the number admitted to the same institution with the same diagnosis during the preceding 3 years. All patients had type 2 diabetes mellitus. In each case, a rapidly spreading ce llulitis followed trauma to the foot, which necessitated emergent incision and drainage. Five patients required extensive fascial and skin debridement because of soft-tissue destruction, and two patients needed below-the-knee amputation because of uncontrolled infection. These cases suggest that non -group A streptococci, like group A streptococci, can cause serious skin an d soft-tissue infections in patients with diabetes that may require aggress ive surgical debridement despite appropriate antibiotic therapy.