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Observational Study
. 2025 Nov 28;51(1):312.
doi: 10.1186/s13052-025-02103-7.

Invasive Group A Streptococcus infections in children during the post-pandemic period: results from a multicenter study in Italy

Elena Chiappini #  1   2 , Marco Renni #  3 , Maia De Luca  4 , Samantha Bosis  5 , Silvia Garazzino  6 , Laura Dotta  7 , Raffaele Badolato  7 , Federica Zallocco  8 , Daniele Zama  9   10 , Antonella Frassanitto  11 , Ilaria Liguoro  12 , Danilo Buonsenso  13 , Claudia Colomba  14 , Lorenza Romani  4 , Giulia Lorenzetti  4 , Federica Ceroni  15 , Marco Denina  6 , Nicolò Monti  3 , Catiuscia Lisi  16 , Luisa Galli  17   16 , Giangiacomo Nicolini  18 , Guido Castelli Gattinara  19 , Andrea Lo Vecchio  20 ; Italian Society of Pediatric Infectious Diseases (SITIP)
Affiliations
Observational Study

Invasive Group A Streptococcus infections in children during the post-pandemic period: results from a multicenter study in Italy

Elena Chiappini et al. Ital J Pediatr. .

Abstract

Background: Group A Streptococcus causes pediatric infections from mild to severe forms. Since late 2022, invasive cases have increased in Europe, possibly due to reduced post-COVID-19 immunity, more respiratory virus circulation, and emergence of virulent strains.

Methods: A retrospective, multicenter observational study was conducted in twelve Italian pediatric Hospitals, including patients under 18 years hospitalized with invasive or severe Group A Streptococcus infection. Data were anonymized and analyzed to identify factors associated with Pediatric Intensive Care Unit (PICU) admission and discharge with sequelae or death.

Results: Seventy-five children with invasive or severe Group A Streptococcus infection were included; the majority (69.3%) were aged 2-10 years. Invasive Group A Streptococcus (iGAS) infection accounted for 58.7% (n = 44) and severe GAS (sGAS) infection for 41.3% (n = 31) of cases. Pediatric Intensive Care Unit admission was required in 45.3% (n = 34) of the entire patient cohort, in this subgroup viral coinfection (OR 5.684, p = 0.003), sepsis/septic shock (OR 4.406, p = 0.003), iGAS diagnosis (OR 4.153, p = 0.005), and procalcitonin (PCT) > 0.5 ng/mL (OR 7.105, p = 0.019) were independently associated with admission; the use of corticosteroids (OR 4.641, p = 0.003) and intravenous immunoglobulin (IVIG) (OR 16.667, p = 0.003) was also significantly more frequent. All patients received empirical β-lactam antibiotics; anti-toxin therapy was administered in 47 patients (62.7%): clindamycin (49.3%), linezolid (16.0%), and rifampicin (1.3%). Mechanical ventilation was required in 24.0% (n = 18), and 49.3% (n = 37) underwent surgery. Post-infectious sequelae occurred in 20.0% (n = 15) and four children died, mostly due to streptococcal toxic shock syndrome.

Conclusion: Pediatric invasive group A streptococcal infection continues to pose a significant clinical challenge, with notable rates of morbidity and mortality, underscoring the need for early recognition and close monitoring of high-risk patients. A widespread use of adjunctive therapies was documented. Continued surveillance and robust clinical research are essential to optimize management strategies and improve patient outcomes.

Keywords: Children; Group A Streptococcal Infections; Invasive disease; Streptococcus pyogenes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the IRCCS Bambino Gesù Children’s Hospital in Rome (Protocol No. 3312_OPBG_2023). Consent for publication: Not applicable: the manuscript does not contain data from any individual person. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of iGAS/sGAS infections by age (per years)
Fig. 2
Fig. 2
Clinical features and organ involvement in children admitted or not to Paediatric Intensive Care (PICU) Created with BioRender.com
See this image and copyright information in PMC

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