An Australian Paediatric Retrieval Service Riding the Wave of Invasive Group A Streptococcal Disease From 2022 to 2024.

Background: From late 2022, there was an increase in cases of invasive group A streptococcus (iGAS) reported in the Northern Hemisphere and there was a similar increase noted in the referrals to the Newborn and Paediatric Emergency Transport service (NETS NSW), in the state of New South Wales (NSW), Australia. This study describes the clinical characteristics and outcomes of children referred to NETS NSW with iGAS disease.

Methods: A retrospective cohort of children referred to NETS NSW for management of iGAS disease between 1st November 2022 to 29th February 2024. Patients included had a confirmed diagnosis of iGAS disease (i.e., on detection of S. pyogenes from a sterile site). Clinical characteristics and outcome data were collected from the medical record.

Results: Seventy-seven cases were referred to NETS NSW of children with confirmed iGAS disease and seventy were retrieved by NETS NSW. Three patients died in the referring hospital; one was retrieved by an interstate service and three improved and stayed locally. A male predominance of 44/77 (57%) was noted, most were children of preschool age (median 4.2 years QR 1.95-8.05), presenting with pneumonia (52/77, 67.5%), septic arthritis (12/77, 16%), or rash 37/68 (54%). There were high rates of bacteraemia (38/77, 49%) and increased mean serum lactate (4.8 mmol/L ± 3.3). High clinical acuity was seen, with most cases retrieved to paediatric intensive care unit (52/77, 68%), often managed with mechanical ventilation (36/77, 47%), effusion drainage (50/77, 65%) and 24/77 (27%) referred via NETS NSW for the Kids ECMO Referral Service (KERS). IVIg was added for 31/64 cases (48%) as supportive care, along with antibiotic therapy. Four children did not survive.

Conclusion: The prevalence of iGAS disease referrals to NETS NSW significantly increased from late 2022 to early 2024. There was a high service demand for NETS NSW to retrieve critically unwell preschool-aged children requiring critical stabilisation and transfer to a paediatric intensive care unit (PICU).