Table 1.
Characteristics of children admitted with GAS infection
| All patients (n = 320) | No PICU admission (n = 172) | PICU admission (n = 148) | p | |
|---|---|---|---|---|
| Sex (male, n, %) | 161 (50%) | 86 (50%) | 75 (51%) | 0.9 |
| Age (months) (IQR) | 47 [27–84] | 57 [36–85] | 40 [21–83] | 0.01 |
| Time interval onset symptoms to hospital admission (n = 251, days) | 3.0 [1.8–6.0] | 3.5 [1.8–6] | 3.0 [1.8–5.7] | 0.67 |
| Immunizations up-to-date (n = 222) | 211 (95%) | 103/110 (94%) | 108/112 (96%) | 0.06 |
| Number of underlying conditions | ||||
| None | 203 (63%) | 107 (62%) | 96 (65%) | 0.11 |
| 1 | 77 (24%) | 48 (28%) | 29 (20%) | |
| ≥ 2 | 40 (13%) | 17 (10%) | 23 (16%) | |
| Underlying conditions | ||||
| Congenital or genetic defect | 18 (5.6%) | 4 (2.3%) | 14 (9.5%) | 0.006 |
| Prematurity | 10 (3.1%) | 5 (2.9%) | 5 (3.4%) | 0.11 |
| Immunodeficiency | 6 (1.9%) | 1 (0.6%) | 5 (3.4%) | 0.19 |
| Cardiac condition | 5 (1.6%) | 2 (1.2%) | 3 (2.0%) | 0.47 |
| Epilepsy | 5 (1.6%) | 0 | 5 (3.4%) | 0.01 |
| Respiratory | 9 (2.8%) | 6 (3.5%) | 3 (2.0%) | 0.12 |
| Haematological | 1 (0.3%) | 0 | 1 (0.7%) | 0.28 |
| Oncological | 1 (0.3%) | 1 (0.6%) | 0 | 0.35 |
| Inflammatory | 2 (0.6%) | 1 (0.6%) | 1 (0.7%) | 0.36 |
| Liver disease | 1 (0.3%) | 0 | 1 (0.7%) | 0.28 |
| Renal disease | 0 | 0 | 0 | NA |
| Metabolic disease | 2 (0.6%) | 1 (0.6%) | 1 (0.7%) | 0.36 |
| Recent surgery | 3 (0.9%) | 1 (0.6%) | 2 (1.4%) | 0.48 |
| Eczema/dermatitis | 11 (3.4%) | 6 (3.5%) | 5 (3.4%) | 0.96 |
| Recent chickenpox | 21 (6.6%) | 10 (5.8%) | 11 (7.4%) | 0.09 |
| Primary infection site | < 0.001 | |||
| None | 47 (15%) | 14 (8%) | 33 (22%) | |
| Lower respiratory tract | 71 (22%) | 14 (8%) | 57 (39%)* | |
| Skin/Soft tissue | 73 (23%) | 50 (29%) | 23 (16%) | |
| Bone/joint | 60 (19%) | 52 (30%) | 8 (5%) | |
| Upper respiratory tract | 46 (14%) | 34 (20%) | 12 (8%) | |
| Intracranial | 18 (6%) | 5 (3%) | 13 (9%) | |
| Peritoneal | 3 (1%) | 1 (1%) | 2 (1%) | |
| Renal | 2 (1%) | 2 (1%) | 0 | |
| Microbiology | 0.11 | |||
| Sterile site positive culture or PCRa | 236 (74%) | 120 (70%) | 116 (78%) | |
| Blood | 145 (61%) | 80 (67%) | 65 (56%) | |
| CSF | 5 (2%) | 2 (2%) | 3 (3%) | |
| Joint fluid | 18 (8%) | 17 (14%) | 1 (1%) | |
| Pleural fluid | 37 (16%) | 3 (3%) | 34 (30%) | |
| Peritoneal fluid | 1 (0.4%) | 0 | 1 (1%) | |
| Tissue | 4 (2%) | 1 (1%) | 3 (3%) | |
| Urine | 1 (0.4%) | 1 (1%) | 0 | |
| Abscess/pus | 26 (11%) | 15 (13%) | 11 (10%) | |
| Intra-operative swab | 13 (6%) | 6 (5%) | 7 (6%) | |
| GAS clinical syndrome, AND | 84 (26%) | 52 (30%) | 32 (22%) | |
| Potential carriage site positive | 68 (21%) | 40 (23%) | 28 (19%) | |
| Elevated ASOT | 7 (2%) | 4 (2%) | 3 (2%) | |
| Pharyngeal RST positive | 9 (3%) | 8 (5%) | 1 (1%) | |
| Inflammatory markers | ||||
| Max CRP (n = 256, mg/L) | 185 (80–286) | 119 (62–228) | 256 (149–328) | < 0.001 |
| Hospital length of stay (n = 318, days) | 11 [6-18] | 8 [4-13] | 17 [11-26] | < 0.001 |
| PICU-free days at day 28 (n = 318) | 28 (23–28) | 28 | 23 [18-25] | < 0.001 |
ASOT antistreptolysin O titre, CRP C-reactive protein, CSF cerebrospinal fluid, GAS group A streptococcal, PCR polymerase chain reaction, PICU paediatric intensive care unit, RST rapid streptococcal antigen test
*34/57 ((69%) patients in PICU and 4/14 (29%) patients not requiring PICU for lower respiratory tract infection had pleural empyema
aBreakdown exceeds 100% as GAS could have been identified from multiple sources per patient