1382. Invasive Infections due to Groupable Streptococci at a Large Veterans Affairs Hospital: Clinical Characteristics and Outcomes

Abstract

Abstract Background Groupable streptococci (A, B, C, etc.) are known to cause a variety of clinical syndromes, including skin and soft tissue infection, primary bacteremia, osteoarticular infection, pneumonia, and endocarditis. However, there is a lack of recent literature on the clinical characteristics and outcomes of these infections. The purpose of this study was to describe the clinical characteristics of patients with invasive infections due to the groupable streptococci, identify risk factors for infection, and evaluate response to antimicrobial therapy. Methods We reviewed medical records of patients identified by the Infection Control service database at our Veterans Affairs (VA) hospital as having an invasive infection due to a groupable Streptococcus spp. Study inclusion criteria were: hospitalization between 2016 – 2019, age >18, and growth of a groupable Streptococcus spp in a clinical specimen from a normally sterile site (excluding urine). Patients were excluded from the study if the positive culture was due to colonization rather than true infection and if inpatient admission was not required. Results A total of 75 patients were identified. The median age was 63; 97% of patients were male; and 52% were Caucasian. Comorbid conditions included diabetes (73%), peripheral vascular disease (33%), malignancy (20%), and chronic kidney disease (15%). The majority of infections was due to group B Streptococcus (72%), followed by group C (21%) and group A (7%). The most common sites of infection were soft tissue (41%) and bone (41%), and a substantial proportion of patients required intensive care (16%). The overall clinical cure rate was 83%. Reinfection occurred within one year in 11% of patients, and one patient (1%) died from another cause prior to completing the prescribed treatment regimen. The overall mortality rate from initial infection was 5%. Conclusion This study demonstrates that the modern clinical cure rate of invasive infections due to the groupable streptococci at a large VA hospital was 83%, even with appropriate source control and correct antimicrobial therapy. A substantial proportion of patients required admission to intensive care. These findings highlight the continued morbidity and mortality of these infections even in the modern era. Disclosures Prathit A. Kulkarni, M.D., Vessel Health, Inc.: Grant/Research Support.