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Volume 13, Number 12—December 2007


Invasive Group A Streptococcal Infection in Older Adults in Long-term Care Facilities and the Community, United States, 1998–20031

Michael C. Thigpen*Comments to Author , Chesley L. Richards*, Ruth Lynfield†, Nancy L. Barrett‡, Lee H. Harrison§, Kathryn E. Arnold¶, Arthur Reingold#, Nancy M. Bennett**, Allen S. Craig††, Ken Gershman‡‡, Paul R. Cieslak§§, Paige Lewis*, Carolyn M. Greene*, Bernard Beall*, Chris A. Van Beneden*, and for the Active Bacterial Core surveillance/Emerging Infections Program Network
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Minnesota Department of Health, Minneapolis, Minnesota, USA; ‡Connecticut Department of Public Health, Hartford, Connecticut, USA; §Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; ¶Georgia Department of Human Resources, Atlanta, Georgia, USA; #University of California at Berkeley School of Public Health, Berkeley, California, USA; **University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; ††Tennessee Department of Health, Nashville, Tennessee, USA; ‡‡Colorado Department of Public Health and Environment, Denver, Colorado, USA; §§Oregon State Public Health, Portland, Oregon, USA; 1Presented at the 42nd Annual Meeting of the Infectious Diseases Society of America, September 30–October 3, 2004, Boston, Massachusetts, USA.;

Main Article

Table 3

Clinical syndromes among persons >65 y with invasive group A streptococcal infection, by residence and overall CFR, ABCs areas, 1998–2003*

Clinical syndrome No. LTCF case-patients (%),
N = 383 No. community-based 
case-patients (%), N = 1,279 p value Overall
CFR, %
Bacteremia without focus 145 (37.9) 406 (31.7) <0.05 25.1
Pneumonia† 97 (25.3) 225 (17.6) <0.01 34.0
Cellulitis† 121 (31.6) 498 (38.9) <0.01 16.3
Septic arthritis† 20 (5.2) 90 (7.0) 0.21 11.8
Osteomyelitis† 7 (1.8) 26 (2.0) 0.80 6.1
STSS 15 (3.9) 82 (6.4) 0.07 55.7
Necrotizing fasciitis 15 (3.9) 80 (6.3) 0.08 36.6
Abscess†‡ 8 (2.3) 47 (3.9) 0.15 14.5

*CFR, case-fatality ratio; ABCs, Active Bacterial Core surveillance; LTCF, long-term care facility; STSS, streptococcal toxic shock syndrome. Case-patients with missing responses for residence type, outcome, or clinical syndrome were excluded from analysis. Data for case-patients could be categorized under >1 syndrome except for case-patients identified as having bacteremia without a focus.
†Occurring in conjunction with isolation of group A streptococcal infection from a sterile site (e.g., blood culture).
‡Data not available for all years. Denominators: LTCF 349; community 1,205.

Main Article

1Presented at the 42nd Annual Meeting of the Infectious Diseases Society of America, September 30–October 3, 2004, Boston, Massachusetts, USA.

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