Thursday, November 30, 2023
|
Variable |
Overall, N = 483 |
2008–2013, n = 89 |
2014–2019, n = 394 |
|---|---|---|---|
| Sex | |||
| F | 228 (47.2) | 48 (53.9) | 180 (45.7) |
| M | 255 (52.8) | 41 (46.1) | 214 (54.3) |
| Age, y, median (interquartile range) | 62 (41–75) | 60 (37–75) | 64 (41–75) |
| Age group, y | |||
| <5 | 24 (5.0) | 4 (4.5) | 20 (5.1) |
| 5–17 | 43 (4.8) | 5 (5.6) | 18 (4.6) |
| 18–34 | 45 (9.3) | 12 (13.5) | 33 (8.4) |
| 35–49 | 58 (12.0) | 10 (11.2) | 48 (12.2) |
| 50–64 | 104 (21.5) | 20 (22.5) | 84 (21.3) |
| 65–79 | 147 (30.4) | 21 (23.6) | 126 (32.0) |
| ≥80 | 92 (17.0) | 17 (19.1) | 65 (16.5) |
| Race/ethnicity | n = 444† | n = 83† | n = 361† |
| Hispanic | 22 (5.0) | 2 (2.4) | 20 (5.5) |
| Non-Hispanic | |||
| White | 390 (87.8) | 74 (89.2) | 316 (87.5) |
| Black | 4 (0.9) | 1 (1.2) | 3 (0.8) |
| American Indian/Alaska Native | 18 (4.1) | 5 (6.0) | 13 (3.6) |
| Asian | 5 (1.1) | 1 (1.2) | 4 (1.1) |
| Native Hawaiian/Pacific Islander | 5 (1.1) | 0 (0.0) | 5 (1.4) |
| Residence type | n = 428* | n = 71* | n = 357* |
| Private residence | 349 (81.5) | 56 (78.9) | 293 (82.1) |
| Long-term care or nursing facility | 63 (14.7) | 13 (18.3) | 50 (14.1) |
| Homeless | 9 (2.1) | 1 (1.4) | 8 (2.2) |
| Correctional facility | 7 (1.6) | 1 (1.4) | 6 (1.7) |
Table 1. Demographics of patients with invasive group A Streptococcus disease, overall and by 6-year periods, Idaho, USA, 2008–2019*
*Values are no. (%) patients except as indicated. †Excludes cases with missing data.
|
Variable |
Unadjusted odds ratio* (95% CI) |
p value |
Adjusted odds ratio† (95% CI) |
p value |
|---|---|---|---|---|
| Sex | ||||
| F | Referent | |||
| M | 1.4 (0.9–2.2) | 0.16 | ||
| Age group, y | ||||
| 0–17 | 1.2 (0.5–2.8) | 0.71 | 1.3 (0.5–3.3) | 0.63 |
| 18–49 | Referent | Referent | ||
| 50–64 | 1.2 (0.6–2.3) | 0.65 | 1.6 (0.7–3.8) | 0.29 |
| 65–79 | 1.7 (0.9–3.2) | 0.13 | 1.7 (0.8–3.8) | 0.16 |
| ≥80 | 1.1 (0.5–2.1) | 0.90 | 1.1 (0.5–2.6) | 0.84 |
| Ethnicity | ||||
| Non-Hispanic | Referent | |||
| Hispanic | 2.4 (0.5–10.4) | 0.25 | ||
| Residence type | ||||
| Private | Referent | Referent | ||
| Long-term care or nursing facility | 0.7 (0.4–1.4) | 0.37 | 0.7 (0.3–1.5) | 0.33 |
| Correctional facility | 1.2 (0.1–9.7) | 0.90 | 1.9 (0.1–36.7) | 0.67 |
| Homeless | 1.5 (0.2–12.5) | 0.69 | 0.7 (0.1–4.8) | 0.74 |
| Underlying conditions | ||||
| Diabetes | 0.9 (0.5–1.5) | 0.68 | ||
| Heart disease: congestive heart failure or coronary artery disease | 1.3 (0.7–2.3) | 0.46 | ||
| Obesity | 1.3 (0.7–2.4) | 0.49 | 1.2 (0.6–2.5) | 0.58 |
| Chronic kidney disease or failure | 1.6 (0.7–3.6) | 0.30 | ||
| Chronic obstructive pulmonary disease | 0.8 (0.4–1.8) | 0.62 | ||
| Cancer | 2.4 (0.7–7.9) | 0.17 | ||
| Immunosuppression | 2.0 (0.5–8.6) | 0.37 | ||
| Hepatitis C or chronic liver disease | 1.5 (0.4–6.9) | 0.57 | ||
| Other‡ | 2.3 (0.3–18.2) | 0.42 | ||
| Any underlying condition | 0.9 (0.5–1.7) | 0.75 | ||
| Other risk factors | ||||
| Skin injury | 1.0 (0.6–1.7) | 0.97 | ||
| Cigarette smoking | 0.9 (0.5–1.9) | 0.82 | ||
| Alcohol abuse | 0.9 (0.3–2.3) | 0.75 | ||
| Injection drug use | 3.4 (0.2–60.0) | 0.40 | 3.2 (0.2–63.0) | 0.45 |
Table 2. Individual risk factor and multivariable analysis of risk factors comparing invasive group A Streptococcus cases during 2014–2019 with cases from the 2008–2013 baseline period, Idaho, USA
*Standard logistic regression analysis performed unless otherwise noted. An odds ratio >1 indicates higher odds of being in the 2014–2019 period. †Firth logistic regression used to account for separation attributable to limited sample size and highly predictive risk factors. For multivariable analysis, results for residence type and injection drug use represent total effect and results for age group and obesity represent direct effect. ‡Other underlying conditions include paralysis, neurologic conditions, and developmental delay.
|
Type of infection or clinical syndrome |
No. (%) patients |
p value‡ |
||
|---|---|---|---|---|
|
Overall, N = 476† |
2008–2013, n = 82† |
2014–2019, n = 394 |
||
| Bacteremia without focus§ | 163 (34.2) | 34 (41.5) | 129 (32.7) | 0.13 |
| Cellulitis | 197 (41.4) | 30 (36.6) | 167 (42.4) | 0.33 |
| Pneumonia | 80 (16.8) | 15 (18.3) | 65 (16.5) | 0.69 |
| Streptococcal toxic shock syndrome | 25 (5.3) | 0 (0.0) | 25 (6.4) | 0.02 |
| Septic arthritis | 24 (5.0) | 6 (7.3) | 18 (4.6) | 0.30 |
| Empyema | 19 (4.0) | 4 (4.9) | 15 (3.8) | 0.65 |
| Necrotizing fasciitis | 12 (2.5) | 4 (4.9) | 8 (2.0) | 0.14 |
| Osteomyelitis | 6 (1.3) | 0 (0.0) | 6 (1.5) | 0.26 |
| Meningitis | 4 (0.8) | 0 (0.0) | 4 (1.0) | 0.36 |
| Other¶ | 3 (0.6) | 1 (1.2) | 2 (0.5) | 0.46 |
Table 3. Clinical syndromes of invasive group A Streptococcus disease, overall and by 6-year periods, Idaho, USA, 2008–2019*
*Cases can have >1 type of infection or clinical syndrome. †Excludes 7 cases with missing data on type of infection or clinical syndrome, all during 2008–2013. ‡By χ2 test. §Group A Streptococcus isolated from blood, with no other clinical syndrome identified. ¶Other includes abscess, epiglottitis, and pelvic inflammatory disease.
|
Risk factor |
No. (%) patients |
||
|---|---|---|---|
|
Overall, N = 432* |
2008–2013, n = 69* |
2014–2019, n = 363* |
|
| Any underlying condition | |||
| No | 113 (26.2) | 17 (24.6) | 96 (26.5) |
| Yes | 319 (73.8) | 52 (75.4) | 267 (73.6) |
| Condition | |||
| Diabetes | 178 (41.2) | 30 (43.5) | 148 (40.8) |
| Heart disease: congestive heart failure or coronary artery disease | 116 (26.9) | 16 (23.2) | 100 (27.6) |
| Obesity | 95 (22.0) | 13 (18.8) | 82 (22.6) |
| Kidney disease: chronic kidney disease or chronic kidney failure | 61 (14.1) | 7 (10) | 54 (14.9) |
| Chronic obstructive pulmonary disease or emphysema | 43 (10.0) | 8 (11.6) | 35 (9.6) |
| Cancer | 38 (8.8) | 3 (4.3) | 35 (9.6) |
| Immunosuppression | 22 (5.1) | 2 (2.9) | 20 (5.5) |
| Hepatitis C or chronic liver disease | 18 (4.2) | 2 (2.9) | 16 (4.4) |
| Other† | 13 (3.0) | 1 (1.4) | 12 (3.3) |
| Total underlying conditions | |||
| 0 | 115 (26.6) | 17 (24.6) | 98 (27.0) |
| 1 | 113 (26.2) | 24 (34.8) | 89 (24.5) |
| 2 | 93 (21.5) | 10 (14.5) | 83 (22.9) |
| ≥3 | 111 (25.7) | 18 (26.1) | 93 (25.6) |
| Skin injury | |||
| Any skin injury | n = 412* | n = 70* | n = 342* |
| No | 211 (51.2) | 36 (51.4) | 175 (51.2) |
| Yes | 201 (47.8) | 34 (48.6) | 167 (48.8) |
| Type of skin injury‡ | n = 201 | n = 34 | n = 167 |
| Nonsurgical wound | 127 (63.2) | 22 (64.7) | 105 (62.9) |
| Surgical wound | 17 (8.5) | 3 (8.8) | 14 (8.4) |
| Trauma§ | 47 (23.4) | 8 (23.5) | 39 (23.4) |
| Burn | 2 (1.0) | 0 | 2 (1.2) |
| Skin breakdown | 3 (1.5) | 1 (2.9) | 2 (1.2) |
| Other | 5 (2.5) | 0 | 5 (3.0) |
| Behavioral risk factors | |||
| Current cigarette smoking¶ | n = 375* | n = 60* | n = 315* |
| No | 310 (82.7) | 49 (81.6) | 261 (82.9) |
| Yes | 65 (17.3) | 11 (18.3) | 54 (17.1) |
| Substance abuse | n = 386* | n = 63* | n = 323* |
| Alcohol abuse | 27 (7.0) | 5 (7.9) | 22 (6.8) |
| Methamphetamine use | 6 (1.6) | 0 | 6 (1.8) |
| Injection drug use | 8 (2.1) | 0 | 8 (2.5) |
| None of the above | 346 (89.6) | 58 (92.1) | 288 (89.2) |
| Other risk factors | n = 389* | n = 66* | n = 323* |
| GAS pharyngitis | 31 (8.0) | 7 (10.6) | 24 (7.4) |
| Household member with GAS | 8 (2.1) | 2 (3.0) | 6 (1.9) |
| Influenza | 12 (3.1) | 4 (6.1) | 8 (2.5) |
| None of the above | 336 (86.4) | 54 (81.8) | 282 (87.3) |
Table 4. Underlying conditions and risk factors of patients with invasive group A Streptococcus disease, overall and by 6-year periods, Idaho, 2008–2019
*Excludes missing data. †Other underlying conditions include paralysis, neurologic conditions, and developmental delay. ‡Data from 201 cases with a skin injury reported. §Cut, laceration, or puncture wounds. ¶Does not include e-cigarette use or vaping.
This activity is intended for infectious disease clinicians, internists, critical care clinicians, diabetologists, dermatologists, and other clinicians caring for patients with invasive group A Streptococcus infection.
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