Methods: The epidemiology, clinical features, and antibiotic prescribing patterns for NGAS among children with throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Children with NGAS were compared to children with Group A Streptococcus (GAS) and negative cultures using uni- and multi-variate analysis. Antibiotic prescribing patterns were evaluated.
Results: A total of 224,328 rapid Streptococcus tests and 116, 578 throat cultures were performed. Clinical analysis was completed for 602 GAS patients, 535 NGAS patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season, but increased with age from 2% at ≤ 5 years to 7% at 18 years. Patients with NGAS were more likely than those with negative cultures to have exudates (20.3% vs. 13.1%, p=0.003) and enlarged tonsils (28.6% vs. 19.3%, p<0.001). Modified Centor scores did not differ between groups (score>2, p=1.0; score>3, p=0.50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs. 24.5%, p=0.003), petechiae (14.0% vs. 3.1%, p<0.001) and modified Centor score >2 (47.8% vs. 27.1%; p<0.001). Of patients with NGAS 65% were prescribed antibiotics.
Conclusion: NGAS likely exists in both a carriage and infectious state and the incidence increases with age. When NGAS causes infection the infection is milder than GAS and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment.
H. M. Frost,
M. C. Hall, None