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Predictors of mortality in beta-hemolytic streptococcal bacteremia: a population-based study
Sari Rantala1, Jaana Vuopio-Varkila, Risto Vuento
1Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. sari.rantala@pshp.fi
Insights
Beta-hemolytic streptococcal bacteremia mortality is higher in group C and G infections. Previous cellulitis and fever are associated with better outcomes in patients with streptococcal bacteremia.
Area of Science:
- Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- Mortality factors for Lancefield group A beta-hemolytic streptococcal bacteremia are documented.
- Limited data exists on mortality factors for groups B, C, and G streptococcal bacteremia.
Purpose of the Study:
- To investigate mortality-associated factors in beta-hemolytic streptococcal bacteremia for groups A, B, C, and G.
- To identify prognostic indicators for patients with streptococcal bacteremia.
Main Methods:
- Retrospective population-based study of 314 adult patients with beta-hemolytic streptococcal bacteremia.
- Data collected over a 10-year period (1995-2004) in the Pirkanmaa area, Finland.
Main Results:
- Overall 30-day case-fatality rate was 13%, highest in group C (22%) and group A (15%).
- Confusion, unconsciousness, dyspnea, alcoholism, and fatal underlying diseases were linked to increased mortality.
- Fever appeared protective; previous cellulitis history showed a protective effect (3% vs. 16% fatality).
- Necrotizing fasciitis had a high fatality rate (38%), while cellulitis had 8%.
Conclusions:
- Previous cellulitis history is a protective factor against death in streptococcal bacteremia.
- Fever is associated with a favorable prognosis in patients with streptococcal bacteremia.
Objectives:
Several factors associated with mortality in Lancefield group A beta-hemolytic streptococcal bacteremia have been described in population-based surveillance studies, whereas such reports on group B, C, and G streptococcal are scant.
Methods:
In this population-based study all 314 episodes of beta-hemolytic streptococcal bacteremia in adult patients in the Pirkanmaa area, Finland, during the 10-year period 1995-2004 were retrospectively reviewed.
Results:
The 30-day case-fatality rate was 13%, being highest in group C (22%); in group A it was 15%, in group B 7%, and in group G 15%. Confusion, unconsciousness and dyspnea as the first sign or symptom were associated with increased case-fatality, while fever seemed to be a protecting factor for death. Alcoholism and ultimately or rapidly fatal underlying disease were significantly associated with increased case-fatality. Among infections of the skin and soft-tissues, necrotizing fasciitis had the highest risk of death (38%), while patients with cellulitis had a case-fatality of 8%. A history of previous cellulitis seemed to protect against death (case-fatality of 3% as compared to 16% among those without such a history (p=0.014)).
Conclusion:
A history of previous cellulitis seemed to be a protecting factor against death. Fever was also associated with a good prognosis.
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