Group a Streptococcal Disease in Paediatric Inpatients: a European Perspective

Purpose: Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. Methods: Prospective, multicenter, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012-2016. Demographic, clinical, microbiological and outcome data were collected. Results: 195 (61%) patients had sepsis. 236 (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%), and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU: more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%), less commonly had SSTI and bone and joint infections (p<0.001), and were younger (median 40 (IQR 21-83) vs 56 (IQR 36-85) months, p=0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p<0·001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring (p<0.001). Conclusions: In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short and long term morbidity. Further advances are required in the prevention and early recognition of GAS disease.