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Group A ß-Hemolytic Streptococcal Bacteremia and Intravenous Substance Abuse: A Growing Clinical Problem?

Group A ß-Hemolytic Streptococcal Bacteremia and Intravenous Substance Abuse: A Growing Clinical... Abstract • Over an 18-month period, the incidence of group A β-hemolytic streptococcal bacteremia rose from an average of 2.5 per 10 000 patient discharges to 17.9. A retrospective analysis was performed comparing patients with group A β-hemolytic streptococcal bacteremia during this 18-month period with those who presented over the preceding 36 months. Most of the increased incidence was attributable to individuals hospitalized with a diagnosis of drug addiction who had concomitant soft-tissue infection, although the absolute number of hospitalized drug addicts did not change during this interval. No common or distinctive group A streptococcal serotypic patterns were discovered. This experience suggests that group A β-hemolytic streptococcal bacteremia and soft-tissue infection may present in epidemic fashion among parenteral drug addicts in the absence of a common source. (Arch Intern Med. 1990;150:89-93) References 1. Keefer CS, Ingelfinger FJ, Spink WW. Significance of hemolytic streptococcic bacteremia: a study of two hundred and forty-six patients . Arch Intern Med . 1937;60:1084-1097.Crossref 2. Dudding B, Humphrey GB, Nesbitt ME. Beta-hemolytic streptococcal diseases in childhood leukemia . Pediatrics . 1969;43:359-364. 3. Hable KA, Horstmeier C, Wold AD, Washington JA. Group A β-hemolytic streptococcemia: bacteriologic and clinical study of 44 cases . Mayo Clin Proc . 1973;48:336-339. 4. Duma RJ, Weinburg AN, Medrek TF, Kuny LJ. Streptococcal infections: a bacteriologic and clinical study of streptococcal bacteremia . Medicine . 1969;48:87-127.Crossref 5. Borg HL, Kish MA, Kaufman CA, Supena RB. Group A streptococcal bacteremia in intravenous drug abusers . Am J Med . 1985;78:569-574.Crossref 6. Ispahami P, Donald FE, Aveline AVD. Streptococcus pyogenes bacteremia: an old enemy subdued but not defeated . J Infect . 1988;16:37-46.Crossref 7. Stamm WE, Feeley JC, Facklam RR. Wound infections due to a group A streptococcus traced to a vaginal carrier . J Infect Dis . 1978;138:287-292.Crossref 8. Gryska RF, O'Dea AE. Postoperative streptococcal wound infection: the anatomy of an epidemic . JAMA . 1970;213:1189-1191.Crossref 9. Decker J, Hammond H, MacArthur M, Bailey J, Fukushima T. Hospital outbreak of streptococcal wound infection: Utah . MMWR . 1976;25:141-142. 10. Roberts FJ. A review of positive blood cultures: identification and source of microorganisms and patterns of sensitivity to antibiotics . Rev Infect Dis . 1980;2:329-339.Crossref 11. Weinstein MP, Reller LB, Murphy JR, Lichenstein KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults, I: laboratory and epidemiologic observations . Rev Infect Dis . 1983;5:35-53.Crossref 12. Young SEJ. Bacteremia 1975-1980: a survey of cases reported to the PHLS communicable disease surveillance centre . J Infect . 1982;5:19-26.Crossref 13. HenkelJS, ArmstrongD, Blevins A, Moody MD. Group A beta-hemolytic streptococcus bacteremia in a cancer hospital . JAMA . 1970;211:983-986.Crossref 14. Bibler MR, Rouan GW. Cryptogenic group A streptococcal bacteremia: experience at an urban general hospital and review of the literature . Rev Infect Dis . 1986;8:941-951.Crossref 15. Dudding B, Humphrey GB, Nesbit ME. Beta-hemolytic streptococcal septicemia in childhood leukemia . Pediatrics . 1969;43:359-364. 16. Christie CDC, Havens PL, Shapiro ED. Bacteremia with group A streptococci in childhood . AJDC . 1988;142:559-561. 17. Trence DK, Khan MY, Gerding DN. β-Hemolytic streptococcal septicemia in adults: association with cold weather in Minnesota . Minn Med . 1981;64:675-679. 18. Tregon CV, Sheagren JN. Staphylococcal endocarditis in parenteral drug abusers: source of the organism . Am Intern Med . 1975;82:788-791.Crossref 19. Rebell GC. Staphylococci and hemolytic streptococci from normal skin and from cutaneous infections . J Invest Dermatol . 1947;8:13-24. 20. Hare R. Haemolytic streptococci in normal people and carriers . Lancet . 1941;1:85-88.Crossref 21. Dudding BA, Burnett JW, Chapman SS, Wannamaker LW. The role of normal skin in the spread of streptococcal pyoderma . J Hyg . 1970;68:19-28.Crossref 22. Ferrieri P, Dajani AS, Wannamaker LW, Chapman SS. Natural history of impetigo I site sequence of acquisition and familial patterns of spread of cutaneous streptococci . J Clin Invest . 1972;51:2851-2862.Crossref 23. Stollerman GH. Global changes in group A streptococcal diseases and strategies for their prevention . Adv Intern Med . 1982;27:373-406. 24. Cone LA, Woodward DR, Schievert PM, Tomory GS. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes . N Engl J Med . 1987;317:146-149.Crossref 25. Veasy LG, Wiedmeier SE, Ormond GS, et al. Resurgence of acute rheumatic fever in the intermountain area of the United States . N Engl J Med . 1986;316:421-427.Crossref 26. Hosier DM, Craemen JM, Teske DW, Weller JJ. Resurgence of acute rheumatic fever . AJDC . 1987;141:730-732. 27. Assay E, Giles R, Veasy LG, et al. Acute rheumatic fever: Utah . MMWR . 1987;36:109. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Group A ß-Hemolytic Streptococcal Bacteremia and Intravenous Substance Abuse: A Growing Clinical Problem?

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390130093013
Publisher site
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Abstract

Abstract • Over an 18-month period, the incidence of group A β-hemolytic streptococcal bacteremia rose from an average of 2.5 per 10 000 patient discharges to 17.9. A retrospective analysis was performed comparing patients with group A β-hemolytic streptococcal bacteremia during this 18-month period with those who presented over the preceding 36 months. Most of the increased incidence was attributable to individuals hospitalized with a diagnosis of drug addiction who had concomitant soft-tissue infection, although the absolute number of hospitalized drug addicts did not change during this interval. No common or distinctive group A streptococcal serotypic patterns were discovered. This experience suggests that group A β-hemolytic streptococcal bacteremia and soft-tissue infection may present in epidemic fashion among parenteral drug addicts in the absence of a common source. (Arch Intern Med. 1990;150:89-93) References 1. Keefer CS, Ingelfinger FJ, Spink WW. Significance of hemolytic streptococcic bacteremia: a study of two hundred and forty-six patients . Arch Intern Med . 1937;60:1084-1097.Crossref 2. Dudding B, Humphrey GB, Nesbitt ME. Beta-hemolytic streptococcal diseases in childhood leukemia . Pediatrics . 1969;43:359-364. 3. Hable KA, Horstmeier C, Wold AD, Washington JA. Group A β-hemolytic streptococcemia: bacteriologic and clinical study of 44 cases . Mayo Clin Proc . 1973;48:336-339. 4. Duma RJ, Weinburg AN, Medrek TF, Kuny LJ. Streptococcal infections: a bacteriologic and clinical study of streptococcal bacteremia . Medicine . 1969;48:87-127.Crossref 5. Borg HL, Kish MA, Kaufman CA, Supena RB. Group A streptococcal bacteremia in intravenous drug abusers . Am J Med . 1985;78:569-574.Crossref 6. Ispahami P, Donald FE, Aveline AVD. Streptococcus pyogenes bacteremia: an old enemy subdued but not defeated . J Infect . 1988;16:37-46.Crossref 7. Stamm WE, Feeley JC, Facklam RR. Wound infections due to a group A streptococcus traced to a vaginal carrier . J Infect Dis . 1978;138:287-292.Crossref 8. Gryska RF, O'Dea AE. Postoperative streptococcal wound infection: the anatomy of an epidemic . JAMA . 1970;213:1189-1191.Crossref 9. Decker J, Hammond H, MacArthur M, Bailey J, Fukushima T. Hospital outbreak of streptococcal wound infection: Utah . MMWR . 1976;25:141-142. 10. Roberts FJ. A review of positive blood cultures: identification and source of microorganisms and patterns of sensitivity to antibiotics . Rev Infect Dis . 1980;2:329-339.Crossref 11. Weinstein MP, Reller LB, Murphy JR, Lichenstein KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults, I: laboratory and epidemiologic observations . Rev Infect Dis . 1983;5:35-53.Crossref 12. Young SEJ. Bacteremia 1975-1980: a survey of cases reported to the PHLS communicable disease surveillance centre . J Infect . 1982;5:19-26.Crossref 13. HenkelJS, ArmstrongD, Blevins A, Moody MD. Group A beta-hemolytic streptococcus bacteremia in a cancer hospital . JAMA . 1970;211:983-986.Crossref 14. Bibler MR, Rouan GW. Cryptogenic group A streptococcal bacteremia: experience at an urban general hospital and review of the literature . Rev Infect Dis . 1986;8:941-951.Crossref 15. Dudding B, Humphrey GB, Nesbit ME. Beta-hemolytic streptococcal septicemia in childhood leukemia . Pediatrics . 1969;43:359-364. 16. Christie CDC, Havens PL, Shapiro ED. Bacteremia with group A streptococci in childhood . AJDC . 1988;142:559-561. 17. Trence DK, Khan MY, Gerding DN. β-Hemolytic streptococcal septicemia in adults: association with cold weather in Minnesota . Minn Med . 1981;64:675-679. 18. Tregon CV, Sheagren JN. Staphylococcal endocarditis in parenteral drug abusers: source of the organism . Am Intern Med . 1975;82:788-791.Crossref 19. Rebell GC. Staphylococci and hemolytic streptococci from normal skin and from cutaneous infections . J Invest Dermatol . 1947;8:13-24. 20. Hare R. Haemolytic streptococci in normal people and carriers . Lancet . 1941;1:85-88.Crossref 21. Dudding BA, Burnett JW, Chapman SS, Wannamaker LW. The role of normal skin in the spread of streptococcal pyoderma . J Hyg . 1970;68:19-28.Crossref 22. Ferrieri P, Dajani AS, Wannamaker LW, Chapman SS. Natural history of impetigo I site sequence of acquisition and familial patterns of spread of cutaneous streptococci . J Clin Invest . 1972;51:2851-2862.Crossref 23. Stollerman GH. Global changes in group A streptococcal diseases and strategies for their prevention . Adv Intern Med . 1982;27:373-406. 24. Cone LA, Woodward DR, Schievert PM, Tomory GS. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes . N Engl J Med . 1987;317:146-149.Crossref 25. Veasy LG, Wiedmeier SE, Ormond GS, et al. Resurgence of acute rheumatic fever in the intermountain area of the United States . N Engl J Med . 1986;316:421-427.Crossref 26. Hosier DM, Craemen JM, Teske DW, Weller JJ. Resurgence of acute rheumatic fever . AJDC . 1987;141:730-732. 27. Assay E, Giles R, Veasy LG, et al. Acute rheumatic fever: Utah . MMWR . 1987;36:109.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1990

References