title: Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003.
abstract: Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons > or =65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons > or =65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. mthigpen@cdc.gov
authors.forename: Michael C
authors.initials: MC
authors.lastname: Thigpen
authors.forename: Chesley L
authors.initials: CL
authors.lastname: Richards
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Barrett
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Arnold
authors.forename: Arthur
authors.initials: A
authors.lastname: Reingold
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
authors.forename: Allen S
authors.initials: AS
authors.lastname: Craig
authors.forename: Ken
authors.initials: K
authors.lastname: Gershman
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cieslak
authors.forename: Paige
authors.initials: P
authors.lastname: Lewis
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Greene
authors.forename: Bernard
authors.initials: B
authors.lastname: Beall
authors.forename: Chris A
authors.initials: CA
authors.lastname: Van Beneden
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D013297:Streptococcus pyogenes; D013997:Time Factors; D014481:United States / Q000453:epidemiology