Effect of underlying immune compromise on the manifestations and outcomes of group A streptococcal bacteremia

- Severity of disease and outcomes of group A streptococcal bacteremia were compared among 25 patients who were immune compromised and 123 who were not immune compromised.
- Group A streptococcal bacteremia is associated with high mortality in immunocompromised hosts.
- Necrotizing fasciitis and septic shock are more likely among immunocompromised patients.

SummaryBackgroundGroup A streptococcal bloodstream infection is the most common presentation of invasive group A streptococcal disease. We sought to determine the impact of immunosuppression on severity of disease and clinical outcomes.MethodsThis retrospective review of 148 patients with at least one positive blood culture for Streptococcus pyogenes from 1/2003 to 3/2013 compared immunocompromised patients with those with no immunocompromise in regards to development of severe complications and mortality.ResultsTwenty-five patients (17%) were immunocompromised; 123 were not. Skin and soft tissue infection occurred in 60% of immunocompromised vs. 38% of non-immunocompromised patients, p = .04. Necrotizing fasciitis and septic shock were significantly more common in immunocompromised patients, p < .0001 and .028, respectively. Mortality at 30 days was 32% in immunocompromised patients vs. 16% in non-immunocompromised patients, p = .05.ConclusionPatients who are immunocompromised are more likely to develop necrotizing fasciitis and septic shock as complications of group A streptococcal bacteremia and have a higher mortality rate than patients who are not immunocompromised.