Group A Streptococcal Bacteremia: A 10-Year Prospective Study

Abstract

In this paper we present a prospective evaluation of 100 patients with Group A Streptococcal (GAS) bacteremia evaluated in our hospital over a 10-year period. Sixty-two patients were intravenous drug users (IVDU); all but 1 of these had an obvious cutaneous portal of entry related to the injection of illicit drugs. Twenty-seven patients had infectious metastasis, and the presence of septic pulmonary embolism was associated with suppurative phlebitis. Four of these patients had endocarditis. In the non-IVDU group, 24 patients had an underlying disease, and 12 were immunosuppressed. In 14 cases the infection was of hospital acquisition; in 35% infection was related to medical manipulations. Comparing the IVDU and non-IVDU groups, GAS bacteremia in IVDU patients is associated with a more benign outcome, a longer time of evolution before diagnosis, and a lower frequency of septic shock and mortality than in non-IVDU patients. Although in the univariate analysis GAS bacteremia was associated with several variables, in the multivariate analysis only the presence of shock and nosocomial acquisition of the infection were independently associated with a fatal outcome. Fifty-two patients were infected with human immunodeficiency virus (HIV); 5 of these were in the non-IVDU group. During the last 5 years of study, GAS bacteremia in our hospital was 39 times more frequent in HIV-infected patients than in patients without HIV. Nine patients presented clinical criteria corresponding to Streptococcal toxic shock syndrome (STSS), although its incidence was lower in the IVDU group. In the non-IVDU group, STSS was more frequent in patients with a necrotizing portal of entry, an age between 20 and 40 years, women, and when the origin of the infection was the skin or soft tissue. Six patients with STSS died, and death was associated with the presence of necrotizing lesions and lower counts of white cells, platelets, or hemoglobin.

A 10-year observational study of Streptococcus dysgalactiae bacteraemia in adults: frequent occurrence among female intravenous drug users

“…Broyles et al [4] reported that 6% (12 out of 212) of patients with invasive S. dysgalactiae infection in the Atlanta metropolitan area (Georgia, USA) and San Francisco Bay metropolitan area (California, USA) were IVDUs. In the 1990s, associations of IV-DU and beta-haemolytic streptococcal bacteraemia were reported with group A Streptococcus (GAS) [12,13]. Similarly, epidemics and endemic disease caused by GAS was reported in IVDUs in our geographic area (Bern, Switzerland) in 2001 [14].…”

The pathogenicity of the Streptococcus genus

“… Species Patient ( n ) age/sex Risk factors Therapy Decease References Cases of bacteremia and general infections Streptococcus viridans 45/M Teeth and gums disease Ill teeth extraction N [ 81 ] Streptococcus salivarius n = 30 Endocarditis 3 [ 82 ] 22/M Group C Streptococcus n = 88 Basic disease 72.7 % β-lactams 25 % [ 83 ] Streptococcus pneumoniae n = 590 19 % [ 84 ] Streptococcus spp. n = 100 Intravenous drug abuse, infectious metastases, purulent vein inflammation, endocarditis 6 [ 85 ] 20–40/F Streptococcus pneumoniae n = 55 Amoxicillin, clarithromycin, azithromycin, ceftriaxone, ceftibuten, cefaclor [ 86 ] 0–5 years Streptococcus pneumoniae n = 71 HIV Third-generation cephalosporins, vancomycin, or erythromycin 28 % [ 87 ] 42/M Streptococcus spp. n = 522 [ 88 ] Viridans group Streptococcus n = 79 (88 episodes) Leukemia/stem cell transplantation Piperacillin and gentamicin, piperacillin and tobramycin, or ceftazidime and tobramycin [ …”