Exploring the Interaction Between Group A Streptococcal Pneumonia and the COVID-19 Pandemic (GASP)

Authors

• Hannah Bray, Infectious Disease Fellow - Corewell Health West
• Jacob Stremers, Infectious Disease Fellow - Corewell Health West
• Marlene Garcia, Infectious Disease Fellow - Corewell Health West
• Felix Bratosin, Infectious Disease Fellow - Corewell Health West
• Adam Caulfield, Microbiology - Corewell Health West
• Dylan Fulmer, Infectious Disease - Corewell Health West
• Zachary Ciochetto, Infectious Disease - Corewell Health West
• Gordana Simeunovic, Infectious Disease - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Group A Streptococcus (GAS) is a known cause of invasive infections (iGAS), with the incidence of GAS pneumonia (GAS PNM) being traditionally low. During the COVID pandemic, the rate of iGAS decreased, followed by a rebound in the years after. Several clusters of GAS PNM were described during this time. Systematic data on GAS PNM epidemiology and outcomes is lacking. In this retrospective study we evaluate the rate of GAS PNM in relation to the pandemic, as well as patient population and outcomes in order to identify risk factors for severe infection.

Among patients hospitalized between April 1st, 2018, and March 31st, 2024, in Corewell Health West in Michigan, with positive GAS blood and sputum culture, we identified those with GAS PNM. A retrospective chart review was conducted to evaluate patients' characteristics and outcomes defined as hospital and ICU length of stay, 90-day all-cause mortality, and readmission rates. Patient characteristics and outcomes were reported as absolute number, percent, mean and median values. The outcomes were evaluated by the time frame (pre-COVID, COVID, and post-COVID) and mortality status using Chi-squared and Fisher exact tests for categorical and Wilcoxon Rank Sum test for numeric variables to assess statistical significance using an alpha of p< 0.05.

The absolute number of GAS PNM increased post-COVID compared with COVID and pre-COVID, but there was no difference in the patients' characteristics or outcomes among the groups. Overall, 35.7% of patients had a viral coinfection and 66.10% needed ICU level of care with the median ICU stay of 3.21 days (9.1, 0.31-23.56) including 50% of patients requiring ventilator support and 50% of patients experiencing shock requiring vasopressors. 26.8% died within 90 days, with a median time between positive culture and death of 2 days (3.5, 0-59). Deceased patients were more likely to have viral coinfection (p=0.022) and lower WBC (0.0088), and to be febrile (p=0.043).

Our data suggests GAS PNM is a severe, rapidly progressive disease, especially with viral coinfection with many patients requiring ICU care with complications including acute renal failure, shock, ventilator dependent respiratory failure, and even death. Recognizing disease early and identifying risk factors for severe disease is vital to improving outcomes.

Recommended Citation

Bray H, Stremers J, Garcia M, Bratosin F, Caulfield A, Fulmer D, Ciochetto Z, Simeunovic G. Exploring the interaction between group A streptococcal pneumonia and the COVID-19 pandemic (GASP). Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1900