Effect of underlying immune compromise on the manifestations and outcomes of group A streptococcal bacteremia

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J Infect


BACKGROUND: Group A streptococcal bloodstream infection is the most common presentation of invasive group A streptococcal disease. We sought to determine the impact of immunosuppression on severity of disease and clinical outcomes.

METHODS: This retrospective review of 148 patients with at least one positive blood culture for Streptococcus pyogenes from 1/2003 to 3/2013 compared immunocompromised patients with those with no immunocompromise in regards to development of severe complications and mortality.

RESULTS: Twenty-five patients (17%) were immunocompromised; 123 were not. Skin and soft tissue infection occurred in 60% of immunocompromised vs. 38% of non-immunocompromised patients, p = .04. Necrotizing fasciitis and septic shock were significantly more common in immunocompromised patients, p < .0001 and .028, respectively. Mortality at 30 days was 32% in immunocompromised patients vs. 16% in non-immunocompromised patients, p = .05.

CONCLUSION: Patients who are immunocompromised are more likely to develop necrotizing fasciitis and septic shock as complications of group A streptococcal bacteremia and have a higher mortality rate than patients who are not immunocompromised.

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Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Child; Child, Preschool; Fasciitis, Necrotizing; Female; Humans; Immunocompromised Host; Infant; Infant, Newborn; Male; Middle Aged; Retrospective Studies; Risk Factors; Shock, Septic; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Young Adult

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