Sistema de Salut de Catalunya
Institut Català de la Salut
[Cobo-Vázquez E] Department of Pediatrics, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain. PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain. [Aguilera-Alonso D] Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. Centro de Investigación Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. [Grandioso-Vas D] Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain. [Gamell A] Infectious Diseases Department, Hospital San Joan de Déu, Barcelona, Spain. [Rello-Saltor V] Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Oltra-Benavent M] Department of Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain. [Lung M] Servei de Microbiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-10-22T12:46:11Z
2025-10-22T12:46:11Z
2025-10
Children; Group A streptococcus; Outbreak
Niños; Estreptococo del grupo A; Brote
Infants; Estreptococ del grup A; Brote
Objectives A global surge in pediatric invasive group A streptococcal infection (iGAS) was reported after autumn 2022. This study analyzed the epidemiology and severity of iGAS in Spain, comparing two periods; P1: pre-outbreak (January 2019-September 2022) versus P2: outbreak (October 2022-July 2023). Methods Children ≤16 years with iGAS enrolled in the Spanish PedGAS-net (2019-2023), were included. Bacterial isolates were analyzed for emm typing, antibiotic susceptibility, and whole genome sequencing. Multivariate analysis identified risk factors for PICU admission and mortality. Results 558 cases were included; 307 (55.1%) were male, with a median age of 43.9 months (IQR:19.3-84.1). There were significantly more iGAS in P2 (35.7 vs. 4.5 cases/month, P < 0.001), with higher PICU admissions (51.3% vs. 30.8%, P < 0.001). Pneumonia was the most common syndrome (32.3%), with pleural effusion in 58.3%. Of the 130 samples available for emm-typing, the most frequent were emm1 (56.1%) and emm12 (27.1%). 245 (43.9%) required PICU admission. Factors associated with PICU were streptococcal toxic shock syndrome (STSS), pneumonia, necrotizing fasciitis, acute kidney failure, and previous consultation before diagnosis. The emm1 (especially M1UK) increased PICU risk. 11 children (2.0%) died. STSS, sepsis, and central nervous system infection were associated with mortality. Conclusion In Spain, pediatric iGAS cases sharply increased during 2022-2023, with a remarkable increase in severity. Epidemiological surveillance of iGAS remains crucial.
This work was partially funded by the Centro de Investigación Biotecnológica en Red de Enfermedades Infecciosas (CIBERINFEC: IM23/INFEC/3).
Article
Published version
English
Pandèmia de COVID-19, 2020-; Infants; Infeccions per estreptococs - Epidemiologia; Streptococcus pyogenes; DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Streptococcal Infections; Other subheadings::Other subheadings::Other subheadings::/epidemiology; ORGANISMS::Bacteria::Firmicutes::Lactobacillales::Streptococcaceae::Streptococcus::Streptococcus pyogenes; NAMED GROUPS::Persons::Age Groups::Child; DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections; HEALTH CARE::Environment and Public Health::Public Health::Disease Outbreaks::Epidemics::Pandemics; ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias grampositivas::infecciones estreptocócicas; Otros calificadores::Otros calificadores::Otros calificadores::/epidemiología; ORGANISMOS::Bacteria::Firmicutes::Lactobacillales::Streptococcaceae::Streptococcus::Streptococcus pyogenes; DENOMINACIONES DE GRUPOS::personas::Grupos de Edad::niño; ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus; ATENCIÓN DE SALUD::ambiente y salud pública::salud pública::brotes de enfermedades::epidemias::pandemias
Elsevier
International Journal of Infectious Diseases;159
https://doi.org/10.1016/j.ijid.2025.107982
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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