Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors

Abstract Introduction Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. Objective To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. Material and methods A retrospective study was conducted on children ≤16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005–July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. Results The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5–88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2–7.2) between June 2005 and May 2009 to 18.9 (15.1–26) between June 2009 and May 2013; P = .057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 months vs 52.6 months, P = .116), had a higher C-reactive protein (24.5 mg/dl vs 10.7 mg/dl, P  Conclusions An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series.