Perianal Cellulites Associated with Group A Streptococci in Iranian Children

Abstract

Methods: Sterile site isolates from infants less than 3 months of age admitted to CHBH were collected prospectively between January 2004 and December 2006. Clinical data were abstracted from the subjects’ medical records. Results: 1388 significant bacterial isolates from blood and cerebrospinal fluid were identified. Six pathogens accounted for 69.5% (965/1388) of the isolates. The most common isolate was Streptococcus agalactiae (n = 206; 14.8%) followed by Staphylococcus aureus (n = 185; 13.3%), Escherichia coli (n = 163; 11.7%), Viridans streptococcus (n = 148; 10.7%), Klebsiella pneumoniae (n = 146; 10.5%) and Acinetobacter baumanii (n = 119; 8.6%). 18% (37/206) of Streptococcus agalactiae isolates and 11% (18/163) of Escherichia coli isolates were from cerebrospinal fluid, compared to ≤10% in other pathogens. 83/172 (40.2%) of Streptococcus agalactiae (GBS) isolates were from infants ≤3 days of age. Incidence of early-onset (EO) GBS sepsis is 1.1/1000 live births. 89/172 (51.7%) of GBS isolates were from infants 4 days to 3 months of age, giving incidence of late-onset sepsis (LOS) of 1.2/1000 live births. Mean age of infants with LOS GBS sepsis is 12.5 days. S. aureus, E. coli, Viridans streptococcus and K. pneumoniae sepsis are predominantly LOS, with mean age of LOS cases being 31, 31, 24 and 35 days old respectively. Conclusions: Vertically transmitted bacteria are a significant cause of sepsis in young infants in South Africa. The increasing incidence of community-acquired Staphylococcus aureus sepsis in young infants is concerning and requires further investigation.