Epidemiology of pediatric invasive group A streptococcus infection in a Saudi tertiary care center.

BACKGROUND

Invasive group A Streptococcus (iGAS) infections in children can cause severe illness and lead to high rates of complications and death. While recent global reports show a rise in pediatric iGAS after the COVID-19 pandemic, there is limited data from Saudi Arabia.

OBJECTIVES

Assess the clinical features, outcomes, and patterns of pediatric iGAS at a major tertiary center in Riyadh.

DESIGN

Retrospective case series study.

SETTING

King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.

PATIENTS AND

METHODS

Pediatric patients aged 14 years or younger who had symptoms of iGAS confirmed by a positive culture from January 2018 to May 2025.

MAIN OUTCOMES MEASURES: Clinical features, outcomes, and patterns of pediatric iGAS.

SAMPLE SIZE: 32 children.

RESULTS

Out of the 585 total infections recorded, 32 cases were classified as iGAS and included in the study. Most infections happened in winter and spring, with (433/585) 74% occurring from November to April. The highest rates of iGAS were seen during the COVID-19 pandemic years. The average age of patients was 4.1 years, and 94% (n=30) had other health problems, mainly congenital heart disease (n=9, 28%) and hematology/oncology (n=8, 25%). Bacteremia was the most common presentation (n=17, 53%), followed by cellulitis/necrotizing fasciitis (n=9, 28%) and pneumonia (n=8, 25%). Eleven children (34%) needed intensive care, and the overall death rate was 9% (3/32), with all deaths in patients who had bacteremia.

CONCLUSION

In our center, pediatric iGAS infections carry a substantial comorbidity and disease severity burden, frequently presenting with complex and aggressive clinical manifestations. These findings underscore the urgent need for heightened vigilance in high-risk children, improved diagnostic precision, and strengthened local surveillance systems to enhance prevention and optimize management of these serious infections.

LIMITATIONS: Single-center, retrospective design and absence of rapid diagnostic testing.