| dc.description.abstract | Invasive group A Streptococcus infections in Gothenburg,
Sahlgrenska University Hospital, January 2008 – June 2013
ABSTRACT
Background:
Invasive
group
A
Streptococcal
infection
(iGAS)
is
a
severe
disease,
often
requiring
admission
to
an
Intensive
Care
Unit
(ICU).
Incidence
of
iGAS
in
Sweden
has
markedly
increased
during
the
last
30
years.
The
reason
for
this
is
not
fully
understood.
Aim:
First,
to
do
a
survey
on
local
epidemiology,
clinical
manifestations
and
treatment
for
iGAS.
Second,
to
investigate
whether
CRP
and
S-‐lactate
can
be
used
as
early
predictors
for
intensive
care
and
death,
and
if
there
is
a
correlation
between
CRP
and
S-‐
lactate.
Method:
A
retrospective
medical
record
review
of
adults
treated
for
iGAS
at
Sahlgrenska
University
Hospital,
Gothenburg
between
1st
January
2008
and
30th
of
June
2013.
Descriptive
analysis
was
used
for
the
first
aim.
For
the
second
we
used
Fisher’s
Exact
Test
for
S-‐lactate,
and
visualization
with
boxplot
for
CRP,
as
predictive
values
for
ICU
and
death.
Pearson’s
analysis
for
correlation
was
performed
correlation
between
CRP
and
S-‐lactate.
Results:
146
patients
(60
female,
86
male,
median
age
61
years)
were
identified
from
medical
records.
Local
incidence
followed
the
same
trend
as
the
national.
Incidence
was
highest
in
November
-‐
May.
The
main
verified
underlying
focuses
were
skin
and
soft
tissue
(48%)
and
lung
(14%).
In
only
4
%
the
throat
was
a
suspected
focus
and
in
14%
of
the
patients
focus
was
unknown.
Antibiotics
were
given
both
as
mono
therapy
and
combined
therapy.
The
most
common
antibiotic
treatment
before
culture
was
cephalosporins
and
PcG
and
aminoglycosides
in
descending
order.
After
etiological
diagnosis
was
confirmed,
the
most
used
antibiotics
were
instead
PcG,
PcV
and
clindamycin.
Twentyeight
%
of
the
patients
(n=41,
median
age
55
y.)
was
admitted
to
ICU,
and
49%
(n=20)
of
those
had
no
major
comorbidity.
Over
all
mortality
rate
within
1
month
after
hospital
discharge
was
12%
(n=17/146,
median
age
79
y.).
Four
of
those
had
no
major
comorbidity.
The
total
number
of
patients
with
S-‐lactate
sample
taken
was
102.
Patients
with
initial
S-‐lactate
<
2.0
mmol/l
were
never
admitted
to
ICU,
however,
7%
of
them
died.
S-‐lactate
2.0
- 3.9
mmol/l
led
to
ICU
in
39%
and
mortality
was
2%.
Among
patients
with
S-‐lactate
≥ 4.0
mmol/l,
56%
were
admitted
to
ICU
and
34%
died.
CRP
was
found
not
to
be
a
predictor
for
intensive
care
and
death.
There was no significant correlation between
initial CRP concentrations and S-lactate.
Conclusions:
We
saw
a
rising
trend
of
iGAS
2008
–
2013,
with
incidence
peaks
during
winter
and
spring,
and
the
main
focuses
were
soft
tissue
and
lung.
Elderly
and
patients
with
major
comorbidities
were
in
the
majority
over
all
and
in
all
subgroups,
but
also
young
and
healthy
were
affected.
Initial
S-‐lactate,
but
not
CRP
concentrations,
was
a
good
predictor
for
disease
severity. | sv |
