Invasive disease by Streptococcus pyogenes: Patients hospitalized for 6 years

Abstract

Introduction and objectiveIn the last years, an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyse the epidemiology and the clinical features of ID due to SGA in a tertiary paediatric hospital. Material and methodsThis was a retrospective study of all in-patients with final diagnosis of ID due to SGA during 6 years (2009–2014) in a paediatric hospital.To consider ID, SGA had to be isolated in sterile samples, in patients with fasciitis necroticans in skin samples or in any sample in patients with the diagnosis of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of the following criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash.Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected. ResultsFifty-two (52) cases were included (12/10,000 of all inpatients); 3 years old was the medium age (p25-75: 1.4–6.9 years) and 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis.Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8–15 days). Three patients presented sequels and one patient died. ConclusionThe ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations.