Preadmission course and management of severe pediatric group A streptococcal infections during the 2022-2023 outbreak: a single-center experience.

Schöbi, Nina; Duppenthaler, Andrea; Horn, Matthias; Bartenstein, Andreas; Keitel, Kristina; Kopp, Matthias V; Agyeman, Philipp; Aebi, Christoph (2024). Preadmission course and management of severe pediatric group A streptococcal infections during the 2022-2023 outbreak: a single-center experience. Infection, 52(4), pp. 1397-1405. Springer-Medizin-Verlag 10.1007/s15010-024-02198-w

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PURPOSE

The massive increase of infections with Group A Streptococcus (GAS) in 2022-2023 coincided in Switzerland with a change of the recommendations for the management of GAS pharyngitis. Therefore, the objective of the present study was to investigate whether the clinical manifestations and management before hospitalization for GAS infection differed in 2022-2023 compared with 2013-2022.

METHODS

Retrospective study of GAS infections requiring hospitalization in patients below 16 years. Preadmission illness (modified McIsaac score), oral antibiotic use, and outcome in 2022-2023 were compared with 2013-2022. Time series were compared with surveillance data for respiratory viruses.

RESULTS

In 2022-2023, the median modified McIsaac score was lower (2 [IQR 2-3] vs. 3 [IQR 2-4], p =  < 0.0001) and the duration of preadmission illness was longer (4 days [3-7] vs. 3 [2-6], p = 0.004) than in 2013-2022. In both periods, withholding of preadmission oral antibiotics despite a modified McIsaac score ≥ 3 (12% vs. 18%, n.s.) or ≥ 4 (2.4% vs. 10.0%, p = 0.027) was rare. Respiratory disease, skeletal/muscle infection, and invasive GAS disease were significantly more frequent in 2022-2023, but there were no differences in clinical outcome. The time course of GAS cases in 2022-2023 coincided with the activity of influenza A/B.

CONCLUSION

We found no evidence supporting the hypothesis that the 2022-2023 GAS outbreak was associated with a change in preadmission management possibly induced by the new recommendation for GAS pharyngitis. However, clinical manifestations before admission and comparative examination of time-series strongly suggest that viral co-circulation played an important role in this outbreak.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Notfallzentrum für Kinder und Jugendliche
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Surgery
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Paediatric Infectiology

UniBE Contributor:

Schöbi, Nina, Duppenthaler, Andrea, Horn, Matthias Thomas, Bartenstein, Andreas, Keitel, Kristina, Kopp, Matthias Volkmar, Agyeman, Philipp Kwame Abayie, Aebi, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0300-8126

Publisher:

Springer-Medizin-Verlag

Language:

English

Submitter:

Pubmed Import

Date Deposited:

06 Mar 2024 11:20

Last Modified:

01 Aug 2024 00:12

Publisher DOI:

10.1007/s15010-024-02198-w

PubMed ID:

38427206

Uncontrolled Keywords:

Streptococcus pyogenes Child Guidelines Invasive Group A Streptococcus Outbreak iGAS

BORIS DOI:

10.48350/193698

URI:

https://boris.unibe.ch/id/eprint/193698

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