TOPLINE

Children with invasive group A streptococcal (iGAS) infections admitted to paediatric ICUs (PICUs) across Austria during the 2022-2024 surge were most often presented with respiratory disease and frequently required advanced organ support, with notable mortality.

METHODOLOGY

• Researchers conducted a nationwide, multicentre, retrospective cohort study to describe the clinical presentation, co-infections, microbiology, organ support requirements, and short-term outcomes in children with iGAS infections admitted to PICUs across Austria.
• They included 70 patients (median age, 4.5 years; 54.3% boys) with iGAS infections who were admitted to the PICU between September 2022 and March 2024.
• iGAS infection was defined according to the established surveillance criteria as a microbiologically confirmed infection from a sterile body site by culture or polymerase chain reaction or the detection of GAS from a non-sterile site in children meeting the clinical criteria for a severe iGAS infection.
• Data were collected using a standardised electronic questionnaire that captured the total number of iGAS admissions and associated fatalities, along with detailed clinical, microbiological, and treatment information for each case.

TAKEAWAY

• Respiratory disease predominated at presentation, with pleural empyema (51.4%), pneumonia (45.7%), sepsis (44.3%), and septic shock (25.7%) being the most common presentations. Co-infections were documented in 55.7% of patients, most frequently influenza A, varicella-zoster virus, and human metapneumovirus infections.
• Mechanical ventilation was required by 72.9% of patients (44.3% invasive and 28.6% non-invasive), and 50.0% required vasoactive therapy. Cardiopulmonary resuscitation was performed in 14.3% of patients, and 10.0% received extracorporeal support, including extracorporeal membrane oxygenation and continuous renal replacement therapy.
• The median PICU stay was 12.5 days. Overall mortality was 14.3%, with 7 of 10 deaths occurring within 24 hours of PICU admission.
• Microbiological confirmation was most frequently obtained from pleural fluid (45.7%) and blood cultures (31.4%), and 40.0% of patients had positive results from multiple specimen sites.

IN PRACTICE

"Our data highlight three priorities: prompt recognition of iGAS with respiratory focus, early hemodynamic support with readiness to escalate to ECMO [extracorporeal membrane oxygenation] in refractory shock, and systematic assessment for respiratory viral and varicella co-infection," the authors wrote.

SOURCE

This study was led by Anna Aichinger, Medical University of Vienna, Vienna, Austria. It was published online on July 29, 2026, in the European Journal of Pediatrics.

LIMITATIONS

The retrospective design, restriction to PICU admissions, and non-standardised testing across centres limited more robust analyses. Validated severity-of-illness scores were unavailable, and diagnoses of initial presentations were retrospectively collected without central verification. Vasoactive support lacked a standardised operational definition.

DISCLOSURES

Open access funding was provided by the Medical University of Vienna. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.