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Background <p>Group A <i>Streptococcus</i> causes pediatric infections from mild to severe forms. Since late 2022, invasive cases have increased in Europe, possibly due to reduced post-COVID-19 immunity, more respiratory virus circulation, and emergence of virulent strains.</p> Methods <p>A retrospective, multicenter observational study was conducted in twelve Italian pediatric Hospitals, including patients under 18&#xa0;years hospitalized with invasive or severe Group A <i>Streptococcus</i> infection. Data were anonymized and analyzed to identify factors associated with Pediatric Intensive Care Unit (PICU) admission and discharge with sequelae or death.</p> Results <p>Seventy-five children with invasive or severe Group A Streptococcus infection were included; the majority (69.3%) were aged 2–10&#xa0;years. Invasive Group A <i>Streptococcus</i> (iGAS) infection accounted for 58.7% (<i>n</i> = 44) and severe GAS (sGAS) infection for 41.3% (<i>n</i> = 31) of cases. Pediatric Intensive Care Unit admission was required in 45.3% (<i>n</i> = 34) of the entire patient cohort, in this subgroup viral coinfection (OR 5.684, <i>p</i> = 0.003), sepsis/septic shock (OR 4.406, <i>p</i> = 0.003), iGAS diagnosis (OR 4.153, <i>p</i> = 0.005), and procalcitonin (PCT) &gt; 0.5&#xa0;ng/mL (OR 7.105, <i>p</i> = 0.019) were independently associated with admission; the use of corticosteroids (OR 4.641, <i>p</i> = 0.003) and intravenous immunoglobulin (IVIG) (OR 16.667, <i>p</i> = 0.003) was also significantly more frequent.</p> <p>All patients received empirical β-lactam antibiotics; anti-toxin therapy was administered in 47 patients (62.7%): clindamycin (49.3%), linezolid (16.0%), and rifampicin (1.3%). Mechanical ventilation was required in 24.0% (<i>n</i> = 18), and 49.3% (<i>n</i> = 37) underwent surgery. Post-infectious sequelae occurred in 20.0% (<i>n</i> = 15) and four children died, mostly due to streptococcal toxic shock syndrome.</p> Conclusion <p>Pediatric invasive group A streptococcal infection continues to pose a significant clinical challenge, with notable rates of morbidity and mortality, underscoring the need for early recognition and close monitoring of high-risk patients. A widespread use of adjunctive therapies was documented. Continued surveillance and robust clinical research are essential to optimize management strategies and improve patient outcomes.</p>

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Invasive Group A Streptococcus infections in children during the post-pandemic period: results from a multicenter study in Italy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月28日

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  • Elena Chiappini,
  • Marco Renni,
  • Maia De Luca,
  • Samantha Bosis,
  • Silvia Garazzino,
  • Laura Dotta,
  • Raffaele Badolato,
  • Federica Zallocco,
  • Daniele Zama,
  • Antonella Frassanitto,
  • Ilaria Liguoro,
  • Danilo Buonsenso,
  • Claudia Colomba,
  • Lorenza Romani,
  • Giulia Lorenzetti,
  • Federica Ceroni,
  • Marco Denina,
  • Nicolò Monti,
  • Catiuscia Lisi,
  • Luisa Galli,
  • Giangiacomo Nicolini,
  • Guido Castelli Gattinara,
  • Andrea Lo Vecchio

摘要

Background

Group A Streptococcus causes pediatric infections from mild to severe forms. Since late 2022, invasive cases have increased in Europe, possibly due to reduced post-COVID-19 immunity, more respiratory virus circulation, and emergence of virulent strains.

Methods

A retrospective, multicenter observational study was conducted in twelve Italian pediatric Hospitals, including patients under 18 years hospitalized with invasive or severe Group A Streptococcus infection. Data were anonymized and analyzed to identify factors associated with Pediatric Intensive Care Unit (PICU) admission and discharge with sequelae or death.

Results

Seventy-five children with invasive or severe Group A Streptococcus infection were included; the majority (69.3%) were aged 2–10 years. Invasive Group A Streptococcus (iGAS) infection accounted for 58.7% (n = 44) and severe GAS (sGAS) infection for 41.3% (n = 31) of cases. Pediatric Intensive Care Unit admission was required in 45.3% (n = 34) of the entire patient cohort, in this subgroup viral coinfection (OR 5.684, p = 0.003), sepsis/septic shock (OR 4.406, p = 0.003), iGAS diagnosis (OR 4.153, p = 0.005), and procalcitonin (PCT) > 0.5 ng/mL (OR 7.105, p = 0.019) were independently associated with admission; the use of corticosteroids (OR 4.641, p = 0.003) and intravenous immunoglobulin (IVIG) (OR 16.667, p = 0.003) was also significantly more frequent.

All patients received empirical β-lactam antibiotics; anti-toxin therapy was administered in 47 patients (62.7%): clindamycin (49.3%), linezolid (16.0%), and rifampicin (1.3%). Mechanical ventilation was required in 24.0% (n = 18), and 49.3% (n = 37) underwent surgery. Post-infectious sequelae occurred in 20.0% (n = 15) and four children died, mostly due to streptococcal toxic shock syndrome.

Conclusion

Pediatric invasive group A streptococcal infection continues to pose a significant clinical challenge, with notable rates of morbidity and mortality, underscoring the need for early recognition and close monitoring of high-risk patients. A widespread use of adjunctive therapies was documented. Continued surveillance and robust clinical research are essential to optimize management strategies and improve patient outcomes.