Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;182(2):697-706.
doi: 10.1007/s00431-022-04718-y. Epub 2022 Nov 30.

Group A streptococcal disease in paediatric inpatients: a European perspective

Navin P Boeddha #  1   2 , Lucy Atkins #  3 , Ronald de Groot  4 , Gertjan Driessen  1   5 , Jan Hazelzet  6 , Werner Zenz  7 , Enitan D Carrol  8   9 , Suzanne T Anderson  10 , Federico Martinon-Torres  11 , Philipp K A Agyeman  12 , Rachel Galassini  13 , Jethro Herberg  13 , Michael Levin  13 , Luregn J Schlapbach  14 , Marieke Emonts  15   16   17 ; EUCLIDS consortium
Collaborators, Affiliations

Group A streptococcal disease in paediatric inpatients: a European perspective

Navin P Boeddha et al. Eur J Pediatr. 2023 Feb.

Erratum in

Abstract

Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections (p < 0.001); and were younger (median 40 (IQR 21-83) vs 56 (IQR 36-85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring (p < 0.001).

Conclusion: In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short- and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease.

What is known: • Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited.

What is new: • In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients.

Keywords: Child; Hospital; Outcome; Streptococcus pyogenes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study design. CONSORT flow chart including and excluding patients
Fig. 2
Fig. 2
Numbers of patients with GAS disease per month (2012–2016 combined). Accumulated numbers of patients with GAS disease over the 5-year study period per month of presentation. Total n = 320
Fig. 3
Fig. 3
Outcome of GAS disease in PICU and ward patients. Relative outcomes of patients with GAS per admission category (PICU or non-PICU)
See this image and copyright information in PMC

References

    1. Dietrich ML, Steele RW. Group A Streptococcus. Pediatr Rev. 2018;39(8):379–391. doi: 10.1542/pir.2017-0207. - DOI - PubMed
    1. Shulman ST, Tanz RR, Dale JB, Steer AC, Smeesters PR. Added value of the emm-cluster typing system to analyze group A Streptococcus epidemiology in high-income settings. Clin Infect Dis. 2014;59(11):1651–1652. doi: 10.1093/cid/ciu649. - DOI - PMC - PubMed
    1. Davies MR, McIntyre L, Mutreja A, Lacey JA, Lees JA, Towers RJ, et al. Atlas of group A streptococcal vaccine candidates compiled using large-scale comparative genomics. Nat Genet. 2019;51(6):1035–1043. doi: 10.1038/s41588-019-0417-8. - DOI - PMC - PubMed
    1. Sanderson-Smith M, De Oliveira DM, Guglielmini J, McMillan DJ, Vu T, Holien JK, et al. A systematic and functional classification of Streptococcus pyogenes that serves as a new tool for molecular typing and vaccine development. J Infect Dis. 2014;210(8):1325–1338. doi: 10.1093/infdis/jiu260. - DOI - PMC - PubMed
    1. Steer AC, Lamagni T, Curtis N, Carapetis JR. Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs. 2012;72(9):1213–1227. doi: 10.2165/11634180-000000000-00000. - DOI - PMC - PubMed