Incidence and Severity of Group a Streptococcal Bacteremia in a Medical Center in Israel, 1981–1994

Abstract

To determine recent trends in the incidence and severity, group A streptococcal (GAS) bacteremia was studied over the last 14 years (1981-1994). There were 116 events of GAS bacteremia, representing 1.7% of all bacteremic episodes, without an increase in recent years. A total of 108 patients were available for study. Underlying conditions were found in 95 patients (88%), including mainly malignant diseases, chronic obstructive pulmonary disease, congestive heart failure and diabetes mellitus. A source of the bacteremia was noted in 71 patients (66%), with skin and soft tissue infection being the major portal of entry. All isolates were susceptible to penicillin. Overall mortality was 21%. Mortality had not increased in recent years, but depended significantly on several clinical factors: increased age; admission temperature; source of bacteremia (highest for GAS bacteremia without an identified source); and underlying conditions (highest for diabetes mellitus and chronic pulmonary disease, absent for patients with no underlying disease). This study shows that neither the incidence nor the severity of GAS bacteremia has increased in recent years. Severity is significantly affected by the source of bacteremia and the presence of underlying conditions.

Group A streptococcus bacteraemia: comparison of adults and children in a single medical centre

“…As in previous reports [4,5,12,13,27,33], softtissue infection was the source of infection identified most commonly in both adults and children. Seven children were coinfected with varicella, which is a well-known predisposing condition for invasive streptococcal infection [29], possibly because of disruption of the skin's integrity and ⁄ or other immunological factors.…”

“…The association between invasive GAS disease and varicella infection has been described previously [21][22][23], and contributed to the development of GAS bacteraemia in seven (18%) of the 38 paediatric patients in the present study. The overall mortality rate was 12%, which was lower than has been reported previously (15-48%) [1,9,12,13,20,[24][25][26][27]. Reported mortality is high (up to 67%) in patients with toxic shock syndrome [13,24].…”

“…The overall mortality rate was 12%, which was lower than has been reported previously (15–48%) [1,9,12,13,20,24–27]. Reported mortality is high (up to 67%) in patients with toxic shock syndrome [13,24].…”