Scerri Laura, Fletcher Mandy, Haggie Stuart, Lutz Tracey, Carmo Kathryn Browning
Newborn & Paediatric Emergency Transport Service NSW, Sydney, Australia.
School of Nursing, University of Tasmania, Hobart, Australia.
J Paediatr Child Health. 2025 Jul;61(7):1128-1133. doi: 10.1111/jpc.70093. Epub 2025 May 23.
From late 2022, there was an increase in cases of invasive group A streptococcus (iGAS) reported in the Northern Hemisphere and there was a similar increase noted in the referrals to the Newborn and Paediatric Emergency Transport service (NETS NSW), in the state of New South Wales (NSW), Australia. This study describes the clinical characteristics and outcomes of children referred to NETS NSW with iGAS disease.
A retrospective cohort of children referred to NETS NSW for management of iGAS disease between 1st November 2022 to 29th February 2024. Patients included had a confirmed diagnosis of iGAS disease (i.e., on detection of S. pyogenes from a sterile site). Clinical characteristics and outcome data were collected from the medical record.
Seventy-seven cases were referred to NETS NSW of children with confirmed iGAS disease and seventy were retrieved by NETS NSW. Three patients died in the referring hospital; one was retrieved by an interstate service and three improved and stayed locally. A male predominance of 44/77 (57%) was noted, most were children of preschool age (median 4.2 years QR 1.95-8.05), presenting with pneumonia (52/77, 67.5%), septic arthritis (12/77, 16%), or rash 37/68 (54%). There were high rates of bacteraemia (38/77, 49%) and increased mean serum lactate (4.8 mmol/L ± 3.3). High clinical acuity was seen, with most cases retrieved to paediatric intensive care unit (52/77, 68%), often managed with mechanical ventilation (36/77, 47%), effusion drainage (50/77, 65%) and 24/77 (27%) referred via NETS NSW for the Kids ECMO Referral Service (KERS). IVIg was added for 31/64 cases (48%) as supportive care, along with antibiotic therapy. Four children did not survive.
The prevalence of iGAS disease referrals to NETS NSW significantly increased from late 2022 to early 2024. There was a high service demand for NETS NSW to retrieve critically unwell preschool-aged children requiring critical stabilisation and transfer to a paediatric intensive care unit (PICU).
自2022年末起，北半球报告的侵袭性A组链球菌（iGAS）病例有所增加，澳大利亚新南威尔士州（NSW）新生儿及儿科紧急转运服务（NETS NSW）接到的转诊病例也出现了类似增加。本研究描述了因iGAS疾病转诊至NETS NSW的儿童的临床特征及转归情况。
对2022年11月1日至2024年2月29日期间因iGAS疾病转诊至NETS NSW进行治疗的儿童进行回顾性队列研究。纳入的患者确诊为iGAS疾病（即从无菌部位检测到化脓性链球菌）。从病历中收集临床特征和转归数据。
77例确诊为iGAS疾病的儿童被转诊至NETS NSW，其中70例被NETS NSW接收。3例患者在转诊医院死亡；1例由州际服务机构接收，3例病情好转并留在当地。男性占优势，为44/77（57%），大多数为学龄前儿童（中位年龄4.2岁，四分位间距1.95 - 8.05岁），表现为肺炎（52/77，67.5%）、化脓性关节炎（12/77，16%）或皮疹37/68（54%）。菌血症发生率较高（38/77，49%），平均血清乳酸水平升高（4.8 mmol/L ± 3.3）。临床急症程度高，大多数病例被转至儿科重症监护病房（52/77，68%），常接受机械通气治疗（36/77，47%）、积液引流（50/77，65%），24/77（27%）通过NETS NSW转诊至儿童体外膜肺氧合转诊服务（KERS）。31/64例（48%）患者加用静脉注射免疫球蛋白（IVIg）作为支持治疗，同时进行抗生素治疗。4名儿童未能存活。
2022年末至2024年初，转诊至NETS NSW的iGAS疾病患病率显著增加。NETS NSW对接收需要紧急稳定病情并转至儿科重症监护病房（PICU）的病情严重的学龄前儿童的服务需求很高。
