Streptococcus pyogenes Bacteremia in Adults in the 21st Century

Abstract

Background Streptococcus pyogenes causes pharyngitis, tonsillitis, cellulitis, and less frequently other clinical syndromes. It is infrequently included in the differential diagnosis of other infectious illnesses. Methods We reviewed the medical records of all adult patients (16 years of age and older) with S. pyogenes bacteremia admitted to our institution during the 10 years from January 1, 2007, to December 31, 2016. We report the epidemiology, source of infection, comorbid conditions, treatment, and mortality for these patients. Results There were 68 cases of S. pyogenes bacteremia during the study period. There were 27 episodes in men (39.7%) and 41 episodes in women (60.3%). The patients' ages ranged from 17 to 91 years with a mean of 58.1 years and a median of 59.5 years. Skin and soft tissue infections with or without necrotizing fasciitis were the most common presentation followed by primary bacteremia, pneumonia, septic bursitis/arthritis, obstetric/gynecologic, and head/neck infections. All strains of S. pyogenes tested during the study period maintained sensitivity to penicillin G. Diabetes mellitus was the most common comorbid condition. Seven of 68 patients died for a mortality rate of 10.3%. Conclusions Bacteremic S. pyogenes infections continue to be a significant clinical problem years into the 21st century. Resident physicians, hospitalists, intensivists, and surgeons should be keenly aware of this information and understand the potential consequences of unrecognized, rapidly progressive group A streptococcal infection. Emergent surgical intervention remains essential to the survival of many of these patients.