Invasive Group A Streptococcal Infection in Older Adults in Long-term Care Facilities and the Community, United States, 1998–20031

Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs).We reviewed cases of invasive GAS infections occurring among persons >65 years of age identifi ed through active, population-based surveillance from 1998 through 2003.We identifi ed 1,762 invasive GAS cases among persons >65 years, including 1,662 with known residence type (LTCF or community).Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population.LTCF casepatients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01).In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death.Additional prevention strategies against GAS infection in this high-risk population are urgently needed.A lthough group A Streptococcus (GAS) most common- ly causes pharyngitis and soft tissue infections (1), it also produces severe invasive disease including bacteremia, pneumonia, necrotizing fasciitis (NF), and streptococcal toxic shock syndrome (STSS), especially at the extremes of age (2,3).In the United States, 9,000-11,000 cases and 1,100-1,800 deaths from invasive GAS infection occur each year (3).Those >65 years of age have the highest incidence and case-fatality rate: nearly a third of all cases and half of all deaths occur in this age group (3).In addition to advanced age, cardiac and vascular disease, diabetes, skin breakdown, corticosteroid use, and malignancy are associated with increased risk for invasive GAS infection among adults (4-8).Because underlying conditions are common among long-term care facility (LTCF) residents, this population may be especially vulnerable to invasive GAS infection.Although outbreaks of invasive GAS infections have been well described among LTCF residents (9-16), the extent and characteristics of sporadic invasive GAS infections in this population have not been well defi ned.Since 1998, the Active Bacterial Core surveillance (ABCs) of the Emerging Infections Program Network (EIP)-a collaboration between the Centers for Disease Control and Prevention (CDC), state health departments, and academic centers-has collected information on residence (LTCF vs. community) of invasive GAS case-patients.We used ABCs data to compare incidence, characteristics, and factors contributing to death from invasive GAS infections of elderly LTCF residents and similar-aged persons residing in the community.