Approach to managing Streptococcus pyogenes (group A streptococcus) bloodstream infections
Streptococcus pyogenes (group A streptococcus) bloodstream infection is a form of invasive group A streptococcal infection that usually follows infection at a primary site, most commonly the skin or soft tissues. Postpartum bacteraemia can occur. Streptococcal toxic shock syndrome is rare.
Recommendations are included in these guidelines for adults and children with S. pyogenes bloodstream infection that is:
- complicated – associated with sepsis, septic shock, toxic shock syndrome, pneumonia, meningitis or necrotising fasciitis
- uncomplicated – not associated with the above complications.
When S. pyogenes bloodstream infection is associated with necrotising fasciitis, surgical debridement is required. If available, hyperbaric oxygen therapy can be considered as an adjunct to surgical debridement, but should not delay surgery.
S. pyogenes bloodstream infection is a notifiable condition. In addition to starting antibiotic therapy, refer patients with confirmed infection to the local public health authority1 so that public health management can be implemented. See also, the Communicable Diseases Network Australia (CDNA) National Guidelines for Public Health Units for the management of invasive Group A Streptococcal (iGAS) disease.
Consider prophylaxis for close contacts of patients with S. pyogenes bloodstream infections – see Prevention of invasive group A streptococcal infection.