Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003

Abstract

Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons > or =65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons > or =65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed.

Figure

Comparison of case-fatality ratio from invasive group A streptococcal infections among persons by age group and residence, Active Bacterial Core surveillance areas, 1998–2003. Blank square, long-term care facility case-patient; black square, community-based case-patient. Case-patients with missing responses for residence type and outcomes were excluded from analysis. *p<0.05 for long-term care facility case-patients versus community-based case-patients. †p<0.05 indicates significance between the following groups: 75–84-year age group versus 65–74-year age group, or >85-year age group versus 65–74-year age group.