Holdstock Victoria, Heppenstall Emily, Corrigan Donna, Eccleston Andrew, Jones Laura, Kalima Pota, Lamb Christopher, McDonald Eisin, McDougall Catherine M, McFadzean Jillian, McKenzie Kathryn, Penman Dawn, Pollock Louisa, Scott Kevin J, Smith Andrew, Turner Alastair, Ure Roisin, van Dijke Margrethe, Zafreen Sadia, Begg Colin, Robertson Nic, Williams Thomas C
From the Paediatric Intensive Care Unit, Royal Hospital for Children, Glasgow.
Paediatric Intensive Care Unit, Royal Hospital for Children and Young People, Edinburgh.
Pediatr Infect Dis J. 2025 Jun 4;44(10):925-30. doi: 10.1097/INF.0000000000004855.
Invasive group A streptococcal disease (iGAS) is an important cause of pediatric morbidity and mortality. We aimed to describe severe, life-threatening, iGAS cases to inform critical care services planning and identify potential opportunities for early intervention to prevent progression to death.
Retrospective, multicenter, national cohort study in Scotland investigating critically unwell iGAS cases ≤15 years old from October 01, 2013 to September 30, 2023. We included children and young people (CYP) who required advanced intensive care or died with iGAS as the primary cause of death. Information collected included demographics, Streptococcus pyogenes emm types, viral coinfections and clinical outcomes.
Eighty-two cases of severe, life-threatening iGAS were identified, with 20 resulting in death. The annual iGAS pediatric intensive care unit (PICU) admission rate was 0.69/100,000 CYP, with a mean annual mortality rate of 0.22/100,000. iGAS PICU admissions dropped during 2020-2021, returned to baseline in 2021-2022, and then increased sharply in 2022-2023 without an increase in death rates. Across the cohort, the predominant emm type was type 1. In 9.8% of cases, GAS was identified using a nonculture molecular method (specific polymerase chain reaction or 16S rRNA sequencing). Prior primary or secondary care contact was sought by 9/20 (45%) of CYP who died; there was no significant association between time-to-care to PICU and illness severity or risk of death. Viral coinfections were common and associated with higher severity scores.
We demonstrate a significant annual burden of severe, life-threatening iGAS at the national level. High rates of viral coinfections and care-seeking before PICU admission or death, suggest potential opportunities for intervention.
侵袭性A组链球菌病（iGAS）是儿童发病和死亡的重要原因。我们旨在描述严重的、危及生命的iGAS病例，为重症监护服务规划提供信息，并确定早期干预以防止病情进展至死亡的潜在机会。
在苏格兰进行的一项回顾性、多中心、全国队列研究，调查2013年10月1日至2023年9月30日期间年龄≤15岁的重症iGAS病例。我们纳入了需要高级重症监护或因iGAS作为主要死亡原因而死亡的儿童和青少年（CYP）。收集的信息包括人口统计学、化脓性链球菌emm型、病毒合并感染和临床结局。
共识别出82例严重的、危及生命的iGAS病例，其中20例死亡。iGAS每年入住儿科重症监护病房（PICU）的发生率为0.69/10万CYP，平均年死亡率为0.22/10万。2020 - 2021年期间iGAS入住PICU的人数下降，2021 - 2022年恢复到基线水平，然后在2022 - 2023年急剧增加，但死亡率没有上升。在整个队列中，主要的emm型是1型。在9.8%的病例中，使用非培养分子方法（特异性聚合酶链反应或16S rRNA测序）鉴定出A组链球菌。9/20（45%）死亡的CYP曾寻求过一级或二级医疗护理；从获得护理到入住PICU的时间与疾病严重程度或死亡风险之间无显著关联。病毒合并感染很常见，且与更高的严重程度评分相关。
我们证明了在国家层面上，严重的、危及生命的iGAS每年造成的负担很大。病毒合并感染率高以及在入住PICU或死亡前寻求医疗护理，提示存在潜在的干预机会。
