Group A streptococcal bacteraemia: experience at a university hospital in Riyadh

A recent increase in the frequency and severity of group A beta-haemolytic streptococcal (GABHS) infections has been reported from several parts of the world. A retrospective analysis of bacteraemic GABHS infections encountered at a major teaching hospital in Riyadh, Saudi Arabia between 1982 and 1993 was performed. The epidemiologic, clinical and laboratory aspects of 29 episodes of GABHS bacteraemia were reviewed, and the differences between frequency and severity of these episodes were compared between the initial (1982-1989) and the late (1990-1993) periods of the study. The overall frequency of GABHS bacteraemia was 0.14 episodes per 1000 admissions with no difference between the initial and the late periods. Seventeen patients were adults and 12 were paediatrics. Adults were mostly females (82%) and paediatrics were predominantly males (75%). Seven episodes (24%) were nosocomial. Most patients (72%) had a predisposing factor for GABHS infections. Primary bacteraemia occurred in 13 patients (45%); and the skin and throat were the major sources of the bacteraemia in the rest of the patients. Shock complicated five episodes (17%) and acute renal failure developed in six (21%) patients. The overall case fatality rate was 21%. All five episodes complicated by shock were in the late period, and the rate of acute renal failure as well as the case fatality rate have doubled in the late vs. the early periods. Although no recent increase in frequency of GABHS bacteraemia was found, invasive GABH infections may have become more severe.