Title:Severe Group A and Group B Streptococcus Diseases at a Pediatric ICU: Are they Still Sensitive to the Penicillins?
VOLUME: 15 ISSUE: 2
Author(s):Kam L. Hon*, Tai C. Chow, Tsun S. Cheung, Wai T. Lam, Lok T. Hung, King W. So, I.P. Margaret and Su Y. Qian
Affiliation:Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Department of Paediatrics, The Chinese University of Hong Kong, Central Ave, Department of Microbiology, The Chinese University of Hong Kong, Central Ave, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045
Keywords:Group A streptococcus, Streptococcal pyogenes, Group B streptococcus, pharyngitis, impetigo, scarlet fever, sepsis,
PIM 2, toxic shock syndrome, mortality.
Abstract:Background: Group A β-hemolytic Streptococcus (GAS) and Group B streptococcus
(GBS) are two common pathogens that are associated with many diseases in children. Severe infections
as a result of these two streptococci are albeit uncommon but associated with high mortality
and morbidity, and often necessitate intensive care support. This paper aims to review the mortality
and morbidity of severe infection associated with GAS and GBS isolations at a Pediatric Intensive
Care Unit (PICU).
Methods: All children admitted to PICU of a teaching hospital between October 2002 and May
2018 with laboratory-proven GAS and GBS isolations were included.
Results: There were 19 patients (0.7% PICU admissions) with streptococcal isolations (GAS, n=11
and GBS, n=8). Comparing to GAS, GBS affected infants were younger (median age 0.13 versus
5.47 years, 95% CI, 1.7-8.5, p=0.0003), and cerebrospinal fluids more likely positive (p = 0.0181).
All GAS and GBS were sensitive to penicillin (CLSI: MICs 0.06 – 2.0 μg/mL), with the majority of
GAS sensitive to clindamycin and erythromycin, and half of the GBS resistant to clindamycin and
erythromycin. Co-infections were prevalent, but viruses were only isolated with GAS (p=0.024).
Isolation of GAS and GBS was associated with nearly 40% mortality and high rates of mechanical
ventilation and inotropic supports. All non-survivors had high mortality (PIM2) and sepsis scores.
Conclusions: Severe GAS and GBS are rare but associated with high mortality and rates of mechanical
ventilation and inotropic supports in PICU. The streptococci are invariably sensitive to
penicillin. The high PIM2 and Sepsis scores suggest that prompt recognition of sepsis and the
timely judicious institution of antibiotics and intensive care support may be life-saving for these
devastating infections.
