scholarly journals 215. Invasive Group A Streptococcus-Associated Hospitalizations and Risk Factors for In-Hospital Mortality Among Adults in California, 2000–2016

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S127
Author(s):  
Ellora Karmarkar ◽  
Seema Jain ◽  
Gail L Sondermeyer Cooksey ◽  
Jennifer Myers ◽  
Amanda Kamali
Keyword(s):  
Risk Factors ◽  
Group A Streptococcus ◽  
Continuous Variable ◽  
Incidence Rates ◽  
Severe Illness ◽  
Hospital Death ◽  
Discharge Data ◽  
Invasive Group ◽  
Group A ◽  
Race Ethnicity

Abstract Background Invasive group A Streptococcus (iGAS) causes severe illness and death but is not vaccine preventable or nationally notifiable. We describe the epidemiology of adult patients hospitalized with iGAS in California and risk factors for in-hospital death. Methods Using 2000–2016 California hospital discharge data, we extracted records for adults (≥18 years) with ≥1 group A Streptococcus (GAS)-associated International Classification of Diseases, Ninth or Tenth Revision discharge diagnosis code (e.g., unspecified GAS; GAS-specific pharyngitis, pneumonia, and sepsis) or known GAS-associated syndromes (e.g., acute rheumatic fever, erysipelas, scarlet fever). To identify patients hospitalized with iGAS, we selected extracted records that also had codes consistent with invasive disease (e.g., sepsis, pneumonia, intubation, or central line placement). We calculated iGAS-associated hospitalization incidence rates per 100,000 population and described patient demographics and comorbidities. We calculated the odds of in-hospital death using multivariable logistic regression (P < 0.05). Results During 2000–2016 in California, 37,532 adults were hospitalized with iGAS; 1,045 (3%) died in-hospital. Mean annual hospitalization incidence was 9.4/100,000 population, and was highest (16.3/100,000) in 2016 (Figure 1). Most patients were male (56%), aged 40–65 (45%) or ≥65 (28%) years, and white (60%); 18% were immunocompromised. The percent of patients who died in-hospital increased with age and was highest among those with comorbidities such as malnutrition, cardiovascular disease (CVD), and chronic kidney disease (CKD) (Figure 2). In a multivariable model including age as a continuous variable, sex, and race-ethnicity, the odds of in-hospital death was significantly increased for patients with diagnosis codes for malnutrition, liver disease, CVD, immunosuppression, and CKD (Figure 2); within the race/ethnicity variable Asian/Pacific Islander patients had a higher odds of death compared with white patients. Conclusion Hospitalization and subsequent in-hospital death due to iGAS is substantial in California. Adults with iGAS who have specific comorbidities are at greater risk for death when hospitalized with iGAS. Disclosures All authors: No reported disclosures.

scholarly journals Increasing Rates of Invasive Group A Streptococcal Disease in Alberta, Canada; 2003–2017

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Gregory J Tyrrell ◽  
Sumana Fathima ◽  
Jocelyne Kakulphimp ◽  
Christopher Bell
Keyword(s):  
Risk Factors ◽  
Drug Use ◽  
Alcohol Abuse ◽  
Case Fatality ◽  
Incidence Rates ◽  
Survey Period ◽  
Invasive Group ◽  
Risk Factor Data ◽  
Group A ◽  
Emm Type

Abstract Background We present an analysis of increasing rates of invasive group A streptococci (iGAS) over a 15-year period in Alberta, Canada. Methods From 2003 to 2017, the emm type of iGAS isolates was identified from patients with iGAS disease in Alberta. Demographic, clinical, and risk factor data were collected. Results A total of 3551 cases of iGAS were identified in Alberta by isolation of a GAS isolate from a sterile site. The age-standardized incidence rates of iGAS increased from 4.24/100 000 in 2003 to 10.24 in 2017. Rates (SD) were highest in those age &lt;1 (9.69) years and 60+ (11.15) years; 57.79% of the cases were male. Commonly identified risk factors included diabetes, hepatitis C, nonsurgical wounds, addiction, alcohol abuse, drug use, and homelessness. The overall age-standardized case fatality rate was 5.11%. The most common clinical presentation was septicemia/bacteremia (41.84%), followed by cellulitis (17.25%). The top 4 emm types from 2003–2017 were emm1, 28, 59, and 12. In 2017, the top 4 emm types (emm1, 74, 101, and 59) accounted for 46.60% of cases. Conclusions The incidence of iGAS disease in Alberta, Canada, has increased from 2003 to 2017. This increase has been driven not by a single emm type, but rather what has been observed is a collection of common and emerging emm types associated with disease. In addition, it is also likely that societal factors are playing important roles in this increase as risk factors associated with marginalized populations (addiction, alcohol abuse, and drug use) were found to have increased during the survey period.

scholarly journals Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jane Oliver ◽  
◽  
Elise Thielemans ◽  
Alissa McMinn ◽  
Ciara Baker ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Incidence Rates ◽  
Surveillance Systems ◽  
Invasive Group ◽  
Australian State ◽  
Life Threatening ◽  
Group A

Abstract Objectives Invasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children. Methods IGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated. Results A total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1–2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, −4 or − 12. Conclusions Robust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.

scholarly journals 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S626-S626
Author(s):  
Gail L Sondermeyer Cooksey ◽  
Amanda Kamali ◽  
Duc Vugia ◽  
Seema Jain
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Negative Binomial ◽  
Incidence Rates ◽  
Hospital Death ◽  
Hiv Diagnosis ◽  
Fungus Infection ◽  
Discharge Data ◽  
Hospitalization Rates

Abstract Background Coccidioidomycosis (CM) is caused by inhalation of spores of the soil-dwelling Coccidioides spp. fungus; infection can lead to severe respiratory or disseminated disease. In California, reported cases increased 222% since 2014 (2,316 cases) peaking in 2017 with 7,466 cases (rate 18.1/100,000 population), the highest annual reported cases on record. We reviewed the California hospital CM data to describe trends, demographics, comorbidities, and risk factors for in-hospital death. Methods Using 2000–2017 California administrative hospital discharge data, we identified hospitalizations with ≥1 CM-associated International Classification of Diseases, Ninth or Tenth diagnosis code. We calculated incidence rates per 100,000 population, assessed trends by negative binomial regression, and compared patient characteristics for potential risk factors for in-hospital death by calculating age-adjusted odds ratios (aOR) using bivariate logistic regression (significance, P < 0.05). Results From 2000 to 2017, 25,372 patients were hospitalized with a CM discharge code in California, and hospitalization rates increased significantly from 2.3 to 5.8/100,000 population (P < 0.01) (Figure 1). Most patients were male (69%), >40 years old (69%), white (40%) or Hispanic (38%), and residents of the higher incidence CM regions in California (52%). Most (83%) were not immunocompromised; only 3% had a human immunodeficiency virus (HIV) diagnosis. A total of 1,951 (8%) patients died in-hospital with more deaths among those with disseminated CM (15%), particularly meningitis (17%), than with pulmonary disease (7%). Frequency of death increased with increasing age (0–19 years [2%], 20–39 years [5%], 40–59 years [7%], 60+ years [13%]). Odds of in-hospital death was highest among patients with HIV (aOR 6.4, 95% CI 5.3–7.7) or chronic kidney disease (aOR 2.6, 95% CI 2.3–2.8) (Figure 2). Conclusion CM-associated hospitalization rates have increased in California in the last 18 years, peaking in 2017, with 1 in 12 patients dying in-hospital. Risk factors for death include disseminated CM, older age, HIV infection, and chronic kidney disease. Clinicians should be aware of these risks in caring for patients hospitalized with CM. Disclosures All Authors: No reported disclosures.

scholarly journals Opportunistic Invasive Infection by Group A Streptococcus During Anti–Interleukin-6 Immunotherapy

2020 ◽  
Author(s):  
Shyra Wilde ◽  
Katherine L Olivares ◽  
Victor Nizet ◽  
Hal M Hoffman ◽  
Suhas Radhakrishna ◽  
...  
Keyword(s):  
Risk Factor ◽  
Interleukin 6 ◽  
Natural Experiment ◽  
Group A Streptococcus ◽  
Interleukin 1 ◽  
Severe Illness ◽  
Invasive Infection ◽  
Invasive Group ◽  
Increase Risk ◽  
Group A

Abstract Invasive group A Streptococcus (GAS) in immunocompetent individuals is largely linked to hypervirulent strains. Congenital immunodeficiencies and those acquired from chronic disease or immunosuppressant drugs also increase risk of severe illness. We recovered GAS from the blood of a patient receiving a biologic inhibitor of interleukin 6 (IL-6). Growth of this serotype M4 isolate in human blood or a murine bacteremia model was promoted by interleukin 1 or IL-6 inhibition. Hyperinvasive M1T1 GAS was unaffected by IL-6 in both models. These findings based on a natural experiment introduce IL-6 signaling deficiencies as a risk factor for invasive GAS.

Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection

2020 ◽  
Vol 13 (12) ◽  
pp. e236800
Author(s):  
Grace Anne McCabe ◽  
Thomas Hardy ◽  
Thomas Gordon Campbell
Keyword(s):  
Group A Streptococcus ◽  
Early Recognition ◽  
Skin Grafting ◽  
Final Diagnosis ◽  
Necrotising Fasciitis ◽  
Invasive Group ◽  
Group A ◽  
Tissue Microscopy ◽  
Periorbital Swelling ◽  
Multidisciplinary Teamwork

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.

Group A Streptococcus Carriage in an Alabama Child-Care Center Following a Fatal Invasive Case

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 1030-1030
Author(s):  
Michael M. Engelgau ◽  
John M. Horan ◽  
Charles H. Woernle ◽  
Banjamin Schwartz ◽  
Richard R. Facklam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Child Care ◽  
Group A Streptococcus ◽  
Care Center ◽  
Fatal Case ◽  
Prophylactic Antibiotic ◽  
Child Care Center ◽  
Antibiotic Administration ◽  
Group A

Carriage of the GAS strain was common and widespread following a single fatal case of invasive GAS disease at the child-care center. Risk factors for GAS T-1 carriage did not identify all carriers. Our findings suggest that widespread culturing is needed to identify all potential carriers. The role of prophylactic antibiotic administration in preventing secondary cases could not be determined.

scholarly journals Sequential Quadriplex Real-Time PCR for Identifying 20 Common emm Types of Group A Streptococcus

2020 ◽  
Vol 59 (1) ◽  
pp. e01764-20
Author(s):  
Srinivasan Velusamy ◽  
Katherine Jordak ◽  
Madeline Kupor ◽  
Sopio Chochua ◽  
Lesley McGee ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Group A Streptococcus ◽  
High Specificity ◽  
The United States ◽  
Rapid Identification ◽  
Invasive Group ◽  
Outbreak Investigations ◽  
Group A ◽  
Culture Negative

ABSTRACTWe developed a sequential quadriplex real-time PCR-based method for rapid identification of 20 emm types commonly found in invasive group A Streptococcus (iGAS) strains recovered through the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance. Each emm real-time PCR assay showed high specificity and accurately identified the respective target emm type, including emm subtypes in the United States. Furthermore, this method is useful for rapid typing of GAS isolates and culture-negative specimens during outbreak investigations.

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