Guidelines
Invasive Group A Streptococcal Infection

Invasive Group A Streptococcal Infection

Definition of Invasive Disease

Invasive Group A Strep (GAS) infection refers to infection in the setting of culture isolation of GAS from a normally sterile site (i.e. blood, pleural fluid, joint fluid, CSF)

Case fatality rate for invasive infection is 30-45%

  • minor trauma to soft tissue (hematoma, bruising, muscle strain)
  • use of NSAIDs
  • Immunocompromise (HIV, steroids)
  • IVDU
  • burns
  • peripheral vascular disease
  • diabetes
  • obesity
  • Necrotizing soft tissue infection (NSTI) with or without obvious portal of entry
  • Pregnancy-associated infection (i.e. postpartum endometritis)
  • Bacteremia
  • occurs in up to 50% of necrotizing soft tissue infections
  • early onset (within hours) of hypotension, tachycardia, organ failure
  • fever or hypothermia, altered mental status
  • soft tissue findings (severe pain at site of minor trauma, localized swelling and erythema, ecchymosis, skin sloughing) progress to deep infection within 24-72 hrs
  • TSS is not always due to Grp A Strep; other pathogens include Staphylococci, and other Strep including Group B