title: Clinical Perineal Streptococcal Infection in Children: Epidemiologic Features, Low Symptomatic Recurrence Rate after Treatment, and Risk Factors for Recurrence.
abstract: OBJECTIVE
  To evaluate the epidemiology of perineal streptococcal infection and recurrence rates following amoxicillin treatment.
  
  
  METHODS
  We used laboratory logs in a single pediatric practice to identify patients 0-18 years of age with perineal cultures positive for group A Streptococcus (GAS) and reviewed their medical charts. We described epidemiologic features, determined recurrence rates following antibiotic treatment, and performed a case-control study to identify possible risk factors for recurrence in patients treated with amoxicillin.
  
  
  RESULTS
  We found a perineal streptococcal infection rate of 4.6 per 10,000 patient encounters and a recurrence rate in 157 patients with perineal streptococcal infection of 12.4% after amoxicillin. In male patients, the predominant site of involvement was the perianal region (86%), and for female patients, the perivaginal area (62%). Nearly 80% of patients were 2-7 years of age (range 18 days-12.5 years). Perineal streptococcal infection and GAS pharyngitis followed a similar seasonal pattern of occurrence with 65% of perineal streptococcal infection occurring October through March. In patients with perineal streptococcal infection, 95% had a concomitant pharyngeal culture positive for GAS. Best predictive factors for recurrence after amoxicillin were longer duration of symptoms prior to diagnosis and having a sibling with perineal streptococcal infection at some time before or after the initial episode.
  
  
  CONCLUSIONS
  Following treatment with amoxicillin, we found a low recurrence rate of 12.4%. Amoxicillin can be expected to be reliable first-line therapy for perineal streptococcal infection.
authors.affiliation: Novant Health Eastover Pediatrics, Charlotte, NC.
authors.forename: Herbert William
authors.initials: HW
authors.lastname: Clegg
authors.affiliation: Novant Health Eastover Pediatrics, Charlotte, NC.
authors.forename: Peter Michael
authors.initials: PM
authors.lastname: Giftos
authors.affiliation: Dickson Advanced Analytics, Carolinas Medical Center, Charlotte, NC.
authors.forename: William Edward
authors.initials: WE
authors.lastname: Anderson
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Edward Lawrence
authors.initials: EL
authors.lastname: Kaplan
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Dwight Richard
authors.initials: DR
authors.lastname: Johnson
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D001003:Anal Canal / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010502:Perineum / Q000382:microbiology*; D010612:Pharyngitis / Q000453:epidemiology / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D035781:Siblings; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000453:epidemiology*; D013297:Streptococcus pyogenes; D014848:Vulvovaginitis / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin