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Group A streptococcus bacteraemia: comparison of adults and children in a single medical centre
O Megged1, A M Yinnon, D Raveh
1Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Group A Streptococcus (GAS) bacteraemia is more common in children than adults, often linked to soft-tissue infections. Underlying conditions and specific clinical factors significantly impact mortality risk in GAS bacteraemia cases.
Area of Science:
- Infectious Diseases
- Pediatrics
- Internal Medicine
Background:
- Group A Streptococcus (GAS) bacteraemia is a serious infection with high morbidity and mortality, frequently linked to soft-tissue infections.
- Limited data exists comparing GAS bacteraemia in adult and pediatric populations.
Purpose of the Study:
- To investigate and compare the clinical characteristics, incidence, and outcomes of GAS bacteraemia in adults and children.
- To identify factors associated with mortality in patients with GAS bacteraemia.
Main Methods:
- Retrospective review of 98 GAS bacteraemia cases (60 adults, 38 children) over a 10-year period (1993-2002).
- Analysis of patient demographics, underlying conditions, tissue involvement, and mortality.
- Statistical comparison between adult and pediatric groups.
Main Results:
- GAS bacteraemia was more prevalent in children (3.3%) than adults (0.6%) and occurred at a higher rate per hospitalization (13/1000 vs. 2/1000).
- Soft-tissue infection was the most common concomitant tissue involvement (62%).
- Adults were more likely to have underlying conditions (88% vs. 13%). Twelve deaths occurred, with only one in a child.
Conclusions:
- GAS bacteraemia presents differently in children and adults, with higher incidence in pediatric populations.
- Underlying conditions in adults and specific clinical parameters like older age, hypotension, and multi-organ dysfunction are associated with increased mortality.
- Further research into pediatric GAS bacteraemia is warranted.
Abstract:
Group A streptococcus (GAS) bacteraemia is often associated with soft-tissue infection, with significant morbidity and mortality. Little is known concerning the differences between adults and children with GAS bacteraemia. Records for 98 of 116 cases of GAS bacteraemia (60 adults and 38 children, aged 7 days to 96 years) occurring during a 10-year period (1993-2002) were located and reviewed. GAS bacteraemia comprised 0.6% of all bacteraemias in adults, compared to 3.3% in children (p < 0.001). The rate of adult GAS bacteraemia was two cases/1000 hospitalisations, compared to 13/1000 in children (p < 0.001). Seventy-six (78%) patients had concomitant tissue involvement, with skin or soft-tissue infection being the most common (62%). Fifty-three (88%) of 60 adults and five (13%) of 38 children had underlying conditions (p < 0.001). Twelve patients died, only one of whom was a child. Parameters associated with mortality were older age, lower temperature, hypotension, a need for surgical intervention, toxic shock syndrome, disseminated intravascular coagulation, thrombocytopenia, lymphopenia, hypocalcaemia, renal failure and acidosis (p < 0.05).
