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Current Clinical Pharmacology

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ISSN (Print): 1574-8847
ISSN (Online): 2212-3938

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Research Article

Severe Group A and Group B Streptococcus Diseases at a Pediatric ICU: Are they Still Sensitive to the Penicillins?

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

Volume 15, Issue 2, 2020

Page: [125 - 131] Pages: 7

DOI: 10.2174/1574884714666190926124714

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.

Keywords: Group A streptococcus, Streptococcal pyogenes, Group B streptococcus, pharyngitis, impetigo, scarlet fever, sepsis, PIM 2, toxic shock syndrome, mortality.

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[1]
Leung AK, Kellner JD. Group A beta-hemolytic streptococcal pharyngitis in children. Adv Ther 2004; 21(5): 277-87.
[http://dx.doi.org/10.1007/BF02850032] [PMID: 15727397]
[2]
Chan SH, Lau SP, Fok TF, Liang ST. Early onset neonatal group B streptococcal infection in Hong Kong. Asia Oceania J Obstet Gynaecol 1986; 12(3): 341-6.
[http://dx.doi.org/10.1111/j.1447-0756.1986.tb00202.x] [PMID: 3535758]
[3]
Leung TN, Hon KL, Leung AK, Group A. Streptococcus disease in Hong Kong children: An overview. Hong Kong Med J 2018; 24(6): 593-601.
[http://dx.doi.org/10.12809/hkmj187275] [PMID: 30416105]
[4]
Liang Y, Liu X, Chang H, et al. Epidemiological and molecular characteristics of clinical isolates of Streptococcus pyogenes collected between 2005 and 2008 from Chinese children. J Med Microbiol 2012; 61(Pt 7): 975-83.
[http://dx.doi.org/10.1099/jmm.0.042309-0] [PMID: 22442290]
[5]
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5(11): 685-94.
[http://dx.doi.org/10.1016/S1473-3099(05)70267-X] [PMID: 16253886]
[6]
Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: A meta-analysis. Pediatrics 2010; 126(3): e557-64.
[http://dx.doi.org/10.1542/peds.2009-2648] [PMID: 20696723]
[7]
Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition the working group on severe streptococcal infections. JAMA 1993; 269: 390-1.
[8]
Lithgow A, Duke T, Steer A, Smeesters PR. Severe group A streptococcal infections in a paediatric intensive care unit. J Paediatr Child Health 2014; 50(9): 687-92.
[http://dx.doi.org/10.1111/jpc.12601] [PMID: 24909187]
[9]
Leon J, Hommer R, Grant P, et al. Longitudinal outcomes of children with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). Eur Child Adolesc Psychiatry 2018; 27(5): 637-43.
[http://dx.doi.org/10.1007/s00787-017-1077-9] [PMID: 29119300]
[10]
Wang P, Ma Z, Tong J, et al. Serotype distribution, antimicrobial resistance, and molecular characterization of invasive group B Streptococcus isolates recovered from Chinese neonates. Int J Infect Dis 2015; 37: 115-8.
[http://dx.doi.org/10.1016/j.ijid.2015.06.019] [PMID: 26141418]
[11]
Verani JR, McGee L, Schrag SJ. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease-Revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59(RR-10): 1-36.
[PMID: 21088663]
[12]
Schuchat A, Deaver-Robinson K, Plikaytis BD, Zangwill KM, Mohle-Boetani J, Wenger JD. The active surveillance study group. Multistate case-control study of maternal risk factors for neonatal group B streptococcal disease. Pediatr Infect Dis J 1994; 13(7): 623-9.
[http://dx.doi.org/10.1097/00006454-199407000-00008] [PMID: 7970951]
[13]
Zangwill KM, Schuchat A, Wenger JD. Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR CDC Surveill Summ 1992; 41(6): 25-32.
[PMID: 1470102]
[14]
Todorova-Christova M, Vacheva R, Decheva A, et al. A study on early-onset neonatal group B streptococcal infection, Bulgaria, 2007-2011. Arch Pediatr 2014; 21(9): 953-60.
[http://dx.doi.org/10.1016/j.arcped.2014.06.023] [PMID: 25066700]
[15]
Hon KL, Chan KH, Ko PL, So KW, Leung AKC. Late Onset Streptococcus agalactiae meningitis following early onset septicemia: A preventable disease? Case Rep Pediatr 2017; 20178418105
[http://dx.doi.org/10.1155/2017/8418105] [PMID: 29098104]
[16]
Hon KL, Fu A, Leung TF, et al. Cardiopulmonary morbidity of streptococcal infections in a PICU. Clin Respir J 2015; 9(1): 45-52.
[http://dx.doi.org/10.1111/crj.12103] [PMID: 24406041]
[17]
Hon KL, Nelson EA. Gender disparity in paediatric hospital admissions. Ann Acad Med Singapore 2006; 35(12): 882-8.
[PMID: 17219000]
[18]
Slater A, Shann F, Pearson G. Paediatric Index of Mortality (PIM) Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29(2): 278-85.
[http://dx.doi.org/10.1007/s00134-002-1601-2] [PMID: 12541154]
[19]
Singer M, Deutschman CS, Seymour CW, et al. The Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315(8): 801-10.
[http://dx.doi.org/10.1001/jama.2016.0287] [PMID: 26903338]
[20]
Marik PE, Taeb AM. SIRS, qSOFA and new sepsis definition. J Thorac Dis 2017; 9(4): 943-5.
[http://dx.doi.org/10.21037/jtd.2017.03.125] [PMID: 28523143]
[21]
Chiappini E, Regoli M, Bonsignori F, et al. Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther 2011; 33(1): 48-58.
[http://dx.doi.org/10.1016/j.clinthera.2011.02.001] [PMID: 21397773]

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