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Group A Streptococcus Meningitis, United States, 1997-2022.

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    Group A Streptococcus (GAS) can cause meningitis, a severe infection with a high fatality rate. Awareness is crucial as clindamycin resistance in GAS meningitis is increasing.

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    Area of Science:

    • Infectious Diseases
    • Microbiology
    • Epidemiology

    Background:

    • Group A Streptococcus (GAS) is a known pathogen but infrequently recognized as a cause of meningitis.
    • Invasive GAS infections can lead to severe outcomes, including meningitis.

    Purpose of the Study:

    • To determine the incidence and case-fatality rates (CFRs) of Group A Streptococcus meningitis in the United States.
    • To analyze antimicrobial resistance patterns, specifically for clindamycin, in GAS meningitis isolates over time.

    Main Methods:

    • Analysis of GAS meningitis cases reported by ten sites in the Active Bacterial Core Surveillance network (1997-2022).
    • Calculation of annual incidence and CFRs.
    • Whole-genome sequencing to determine antimicrobial resistance profiles.

    Main Results:

    • Annual incidence of GAS meningitis ranged from 0.02 to 0.07 cases/100,000 persons, with the highest incidence in infants (<1 year).
    • GAS meningitis exhibited a higher CFR (19.4%) compared to other common meningitis pathogens.
    • Clindamycin resistance in GAS meningitis isolates significantly increased from 3.2% (1997-2002) to 17.7% (2018-2022).

    Conclusions:

    • Group A Streptococcus meningitis is an uncommon but severe manifestation of invasive GAS disease.
    • Healthcare providers should maintain a high index of suspicion for GAS meningitis due to its significant CFR.
    • The rising clindamycin resistance in GAS meningitis necessitates careful consideration of treatment strategies.