Streptococcus pyogenes Bacteraemia: A 27-year Study in a London Teaching Hospital

Abstract

The clinical and epidemiological features of 120 episodes of Streptococcus pyogenes bacteraemia in St. Thomas' Hospital between 1970 and 1997 were analysed. One-third of episodes were nosocomial. M1 was the most common serotype, and 29% of strains were non-typable. There was a variety of presenting features, but nearly half of the patients had cellulitis, 15% were shocked, and 6% had necrotic infections. There was no focus of infection in 13%. 54% of patients had an underlying disease, and 23% of infections were associated with a medical procedure or device. The mortality rate was 19%, and was associated with shock, coma, no focus of infection, and underlying disease. Since 1989, the annual incidence has more than doubled, and M1 strains and necrotic infections have increased, but the mortality rate and the proportion of patients presenting with shock have decreased, and the increase in cases involved many different M-types.

Invasive group A streptococcal infections in childhood: Experience in North Yorkshire

“…A local study such as this yields relatively small numbers of patients but we believe that it allows a more consistent and inclusive approach than can be achieved in broader national or regional investigations. We found that childhood infection accounted for 22% of all GAS bacteraemias in the district, a similar figure to those reported by others (ranging from 9% to 57%, typically 14-28%) [4,8,[10][11][12][13], and in our 12-year study we found that it made up 17% of all invasive GAS infections without proven bacteraemia. The incidence of detected bacteraemia in our paediatric population, ranging from 5.9 cases (in age group …”

“…Our second study of hospitalised patients with invasive GAS infection revealed that bacteraemic cases in children were outnumbered at least two-or three-fold by those who were not proved bacteraemic. The spectrum of clinical conditions associated with invasive GAS in childhood was wide (see Table 3) and generally resembled those reported by others [1,[13][14][15][16][17][18]. Taken together, the range of possible manifestations is very similar to that seen in adults, although certain clinical forms such as varicella-or pharyngitis-associated infection, bone and joint infections and abscess may predominate.…”

“…Reported case series and surveys of serious group A streptococcal (GAS) infection [1][2][3][4][5][6][7][8][9][10][11][12][13] have usually included some childhood infections as part of the spectrum encountered, but there have been relatively few studies reporting more specifically on this age group [14][15][16][17][18][19][20]. Over many years we have accumulated a database of local cases of invasive GAS infection in patients of all ages for study.…”

Automated Ribotyping and Pulsed-Field Gel Electrophoresis Reveal a Cluster of Group A Streptococci in Intravenous Drug Abusers

“…The cluster of invasive GAS observed in blood cultures from IVDA in the greater Zurich area was unexpected, even if a higher prevalence of invasive GAS infections in IVDA has been described previously [5,9]. Additional investigation is warranted.…”

“…Risk factors for invasive disease include diabetes, alcoholism, HIV infection, malignancy, lack of skin integrity, rectal surgery, abortion, childbirth and in children varicella [1]. Invasive GAS infections may also be more prevalent in homeless persons, or patients with inadequate access to medical care, including IVDA [5]. All six patients with IVDA described here had more than one risk factor (Table 1).…”