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Peer-reviewedCC BY 4.0Infection

Outcomes and associated risk factors among hospitalisations attributed to invasive group A streptococcal disease in Northern Queensland, Australia: a 21-year population-based data linkage study

  • Himali Ratnayake1
  • Damon Eisen1
  • Oyelola Adegboye2,3
  • Anton Pak4
  • Emma McBryde5,6
6 affiliations
  1. 1College of Medicine and Dentistry, James Cook University, Townsville, QLD Australia
  2. 2Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
  3. 3Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD Australia
  4. 4Centre for Business and Economics of Health, The University of Queensland, Brisbane, QLD Australia
  5. 5Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD Australia
  6. 6Burnet Institute, 85 Commercial Road, Melbourne, 3004 Victoria Australia
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Abstract

Purpose: Invasive group A Streptococcus (iGAS) disease is associated with substantial morbidity and mortality. This study aimed to assess the outcomes of iGAS infection and associated risk factors in Northern Queensland, Australia.

Methods: A retrospective cohort study was conducted using linked hospital data from 2000 to 2020. iGAS cases were identified using ICD-10-AM diagnosis codes in administrative health datasets. Mortality and disease burden were analysed, and risk factors for adverse outcomes were assessed using logistic regression and competing risks regression. Disability-Adjusted Life Years (DALYs) were estimated to quantify disease burden.

Results: A total of 933 iGAS related hospitalisations were identified among 870 individuals. The mean age of the cohort was 45 years (SD = 24), with a median age of 61 years (IQR: 48–77 years). Hospitalised case fatality rate was 5.2%. Intensive Care Unit (ICU) admission was required for 219 patients (23.5%). Readmissions occurred in 2.0% of cases, and 3.6% experienced recurrent infection. Most deaths were attributable to sepsis (80%), with necrotising fasciitis (18%) and septic shock (13.3%) also contributing. In multivariable analysis, age ≥ 60 years was associated with lower odds of ICU admission, while female sex, non-Indigenous status, higher Socio-Economic Indexes for Areas (SEIFA) decile, cardiac disease, and renal failure were associated with increased odds of ICU admission (p < 0.01). Older age, non-Indigenous status and renal failure were significantly associated with increased mortality (p < 0.01). The total DALY burden was 1,375 years.

Conclusion: iGAS imposes a substantial health burden in Northern Queensland, characterised by significant morbidity and high advanced health resource utilisation. Identification of high-risk groups highlights opportunities for targeted prevention of adverse health outcomes of iGAS.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02940-6.

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Cite

BibTeXRIS
BibTeX
@article{ratnayake2026outcomes,
  title = {{Outcomes and associated risk factors among hospitalisations attributed to invasive group A streptococcal disease in Northern Queensland, Australia: a 21-year population-based data linkage study}},
  author = {Himali Ratnayake and Damon Eisen and Oyelola Adegboye and Anton Pak and Emma McBryde},
  journal = {Infection},
  year = {2026},
  month = sep,
  doi = {10.1007/s15010-026-02940-6},
  url = {https://doi.org/10.1007/s15010-026-02940-6},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Outcomes and associated risk factors among hospitalisations attributed to invasive group A streptococcal disease in Northern Queensland, Australia: a 21-year population-based data linkage study
AU  - Himali Ratnayake
AU  - Damon Eisen
AU  - Oyelola Adegboye
AU  - Anton Pak
AU  - Emma McBryde
PY  - 2026
DA  - 2026/09/02
JO  - Infection
DO  - 10.1007/s15010-026-02940-6
UR  - https://doi.org/10.1007/s15010-026-02940-6
AB  - Purpose: Invasive group A Streptococcus (iGAS) disease is associated with substantial morbidity and mortality. This study aimed to assess the outcomes of iGAS infection and associated risk factors in Northern Queensland, Australia.  Methods: A retrospective cohort study was conducted using linked hospital data from 2000 to 2020. iGAS cases were identified using ICD-10-AM diagnosis codes in administrative health datasets. Mortality and disease burden were analysed, and risk factors for adverse outcomes were assessed using logistic regression and competing risks regression. Disability-Adjusted Life Years (DALYs) were estimated to quantify disease burden.  Results: A total of 933 iGAS related hospitalisations were identified among 870 individuals. The mean age of the cohort was 45 years (SD = 24), with a median age of 61 years (IQR: 48–77 years). Hospitalised case fatality rate was 5.2%. Intensive Care Unit (ICU) admission was required for 219 patients (23.5%). Readmissions occurred in 2.0% of cases, and 3.6% experienced recurrent infection. Most deaths were attributable to sepsis (80%), with necrotising fasciitis (18%) and septic shock (13.3%) also contributing. In multivariable analysis, age ≥ 60 years was associated with lower odds of ICU admission, while female sex, non-Indigenous status, higher Socio-Economic Indexes for Areas (SEIFA) decile, cardiac disease, and renal failure were associated with increased odds of ICU admission (p < 0.01). Older age, non-Indigenous status and renal failure were significantly associated with increased mortality (p < 0.01). The total DALY burden was 1,375 years.  Conclusion: iGAS imposes a substantial health burden in Northern Queensland, characterised by significant morbidity and high advanced health resource utilisation. Identification of high-risk groups highlights opportunities for targeted prevention of adverse health outcomes of iGAS.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02940-6.
SN  - 0300-8126
SN  - 1439-0973
ER  -