Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Severe paediatric invasive group A streptococcal infections at Starship Children’s Hospital, Auckland, Jan 2023 - Jan 2025 (#56)

Amanda M Taylor 1 2 , Emma J Best 2 3 , Rebecca Smith 4 , Andrew Fox-Lewis 5 , Rachel H Webb 2 3 6
  1. Department of Paediatric Infectious Diseases, Starship Childrens Hospital, Auckland, new zealand
  2. Department of Paediatrics, University of Auckland,
  3. Paediatric Infectious Diseases, Starship Children's Hospital, Auckland District Health Board, Auckland
  4. Paediatric Intensive Card Unit, Starship Children's Hospital, Auckland, New Zealand
  5. Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  6. Kidz First Hospital, Counties Manukau District Health Board, Auckland

Background and aims

Many regions have reported increases in invasive group A streptococcal disease (iGAS) following the waning of the global COVID-19 pandemic, including Australia,1 the UK2 and Europe.3 NZ has longstanding high rates of streptococcal disease.4,5 Starship Children’s Hospital in Auckland has the sole Paediatric Intensive Care Unit (PICU) and paediatric ECMO facility in NZ. We aimed to describe the contemporary profile and outcomes of children with severe iGAS at Starship Hospital.

Methods

Prospective surveillance Jan 2023 – Jan 2025. Children with iGAS admitted to PICU, along with those undergoing surgical procedures and those with intracranial infections, were included.  

Results

We identified 51 children, of whom 35 were admitted to PICU. Median age was 4 years. Empyema was the most common focus (23 cases). Other presentations included meningitis (8), osteoarticular infection (8), mastoiditis (3) and necrotising fasciitis (5). Median PICU length of stay was 7 days (IQR 5-20 days). PICU management included ECMO (8), renal dialysis (9), vasopressors (23).  There was one death. Six children underwent amputations or major reconstructive surgery due to necrotising fasciitis (2) or purpura fulminans (4).

Conclusion

iGAS is a leading cause of PICU admission for community-onset sepsis at Starship Hospital. We identified several cases of purpura fulminans and meningitis, which are uncommonly reported in iGAS literature. Molecular characterisation of isolates is underway and will be reported. Severe paediatric disease and adverse outcomes highlight the need to address evidence gaps regarding iGAS management and to include children in future clinical trials. 

  1. Abo YN, Oliver J, McMinn A et al. Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges. Lancet Reg Health West Pac. 2023 Aug 22;41:100873. doi: 10.1016/j.lanwpc.2023.100873
  2. Lees EA, Williams TC, Marlow R, et al.Group A Streptococcal Disease Consortium. Epidemiology and Management of Pediatric Group A Streptococcal Pneumonia With Parapneumonic Effusion: An Observational Study. Pediatr Infect Dis J. 2024 Sep 1;43(9):841-850.
  3. Nygaard U, Hartling UB, Munkstrup C, et al. Invasive group A streptococcal infections in children and adolescents in Denmark during 2022-23 compared with 2016-17 to 2021-22: a nationwide, multicentre, population-based cohort study. Lancet Child Adolesc Health. 2024 Feb;8(2):112-121.
  4. Ammar S, Anglemyer A, Bennett J et al. Post-pandemic increase in invasive group A strep infections in New Zealand. J Infect Public Health. 2024 Nov;17(11):102545.
  5. Williamson DA, Morgan J, Hope V, Fraser JD, Moreland NJ, Proft T, Mackereth G, Lennon D, Baker MG, Carter PE. Increasing incidence of invasive group A streptococcus disease in New Zealand, 2002-2012: a national population-based study. J Infect. 2015 Feb;70(2):127-34.