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A multi-center clinical investigation on invasive Streptococcus pyogenes infection in China, 2010-2017
Chun-Zhen Hua1, Hui Yu2, Hong-Mei Xu3
1Division of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China. huachunzhen@zju.edu.cn.
Insights
Invasive group A Streptococcus (S. pyogenes) infections are serious in Chinese children, often starting as skin infections and leading to sepsis. Streptococcal toxin shock syndrome (STSS) was a major cause of death, highlighting the need for continued surveillance.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Invasive group A Streptococcus (S. pyogenes) infections are rare but severe pediatric diseases with high mortality.
- Limited data exists on the clinical and laboratory features of invasive S. pyogenes in Chinese children.
Purpose of the Study:
- To characterize the clinical and laboratory aspects of invasive S. pyogenes infections in pediatric patients in China.
Main Methods:
- A retrospective study was conducted between 2010-2017.
- Included pediatric patients with S. pyogenes identified from normally sterile sites in 9 tertiary hospitals.
- Data collected on clinical presentation, laboratory findings, treatment, and outcomes.
Main Results:
- 66 cases were identified, predominantly male (56.1%) with a median age of 3 years.
- Sepsis was the most common presentation (97.0%), often originating from skin/soft tissue infections (42.4%) or pneumonia (25.8%).
- Streptococcal toxin shock syndrome (STSS) occurred in 22.7% of patients, and 19.7% died, with STSS being a key factor in mortality.
Conclusions:
- Invasive S. pyogenes infections in Chinese children frequently originate from skin/soft tissue infections.
- Streptococcal toxin shock syndrome (STSS) is a significant cause of mortality in this population.
- Continuous surveillance is crucial for better understanding and management of invasive S. pyogenes disease.
Background:
Invasive S. pyogenes diseases are uncommon, serious infections with high case fatality rates (CFR). There are few publications on this subject in the field of pediatrics. This study aimed at characterizing clinical and laboratory aspects of this disease in Chinese children.
Patients And Methods:
A retrospective study was conducted and pediatric in-patients with S. pyogenes infection identified by cultures from normally sterile sites were included, who were diagnosed and treated in 9 tertiary hospitals during 2010-2017.
Results:
A total of 66 cases were identified, in which 37 (56.1%) were male. The median age of these patients, including 11 neonates, was 3.0 y. Fifty-nine (89.4%) isolates were determined from blood. Fever was the major symptom (60/66, 90.9%) and sepsis was the most frequent presentation (64/66, 97.0%, including 42.4% with skin or soft tissue infections and 25.8% with pneumonia. The mean duration of the chief complaint was (3.8 ± 3.2) d. Only 18 (27.3%) patients had been given antibiotics prior to the hospitalization. Among all patients, 15 (22.7%) developed streptococcal toxin shock syndrome (STSS). No S. pyogenes strain was resistant to penicillin, ceftriaxone, or vancomycin, while 88.9% (56/63) and 81.4% (48/59) of the tested isolates were resistant to clindamycin and erythromycin respectively. Most of the patients were treated with β-lactams antibiotics and 36.4% had been treated with meropenem or imipenem. Thirteen (19.7%) cases died from infection, in which 9 (13.6%) had complication with STSS.
Conclusions:
Invasive S. pyogenes infections often developed from skin or soft tissue infection and STSS was the main cause of death in Chinese children. Ongoing surveillance is required to gain a greater understanding of this disease.
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