title: Effect of underlying immune compromise on the manifestations and outcomes of group A streptococcal bacteremia.
abstract: Group A streptococcal bloodstream infection is the most common presentation of invasive group A streptococcal disease. We sought to determine the impact of immunosuppression on severity of disease and clinical outcomes.
  
  
  
  This retrospective review of 148 patients with at least one positive blood culture for Streptococcus pyogenes from 1/2003 to 3/2013 compared immunocompromised patients with those with no immunocompromise in regards to development of severe complications and mortality.
  
  
  
  Twenty-five patients (17%) were immunocompromised; 123 were not. Skin and soft tissue infection occurred in 60% of immunocompromised vs. 38% of non-immunocompromised patients, p = .04. Necrotizing fasciitis and septic shock were significantly more common in immunocompromised patients, p < .0001 and .028, respectively. Mortality at 30 days was 32% in immunocompromised patients vs. 16% in non-immunocompromised patients, p = .05.
  
  
  
  Patients who are immunocompromised are more likely to develop necrotizing fasciitis and septic shock as complications of group A streptococcal bacteremia and have a higher mortality rate than patients who are not immunocompromised.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Linder
authors.affiliation: Henry Ford Health System, USA.
authors.forename: Leen
authors.initials: L
authors.lastname: Alkhouli
authors.affiliation: Henry Ford Health System, USA.
authors.forename: Mayur
authors.initials: M
authors.lastname: Ramesh
authors.affiliation: Henry Ford Health System, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Alangaden
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, USA; Veterans Affairs Ann Arbor Healthcare System, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, USA. Electronic address: mmiceli@med.umich.edu.
authors.forename: Marisa H
authors.initials: MH
authors.lastname: Miceli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000276:immunology; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000276:immunology; D013290:Streptococcal Infections / Q000453:epidemiology / Q000276:immunology; D013297:Streptococcus pyogenes; D055815:Young Adult
keywords: Bacteremia; Group A Streptococcus; Immunosuppression; Necrotizing fasciitis; Streptococcus pyogenes; Toxic shock syndrome