421 - Trends and Outcomes of Streptococcus anginosus Group Complicated Pediatric Head and Neck Infections in Hawai’i

Publication Number: 2409.421

Kokoro Yamazaki, University of Hawaii at Manoa, Honolulu, HI, United States; Kyra Len, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Cheryl Okado, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Chieko Kimata, Hawaii Pacific Health, Honolulu, HI, United States; Andrea Siu, Hawaii Pacific Health, Honolulu, HI, United States

Background: The Streptococcus anginosus group (SAG) are increasingly recognized as pathogens causing serious invasive infections in the head and neck regions. Increased intracranial SAG infections were noted immediately after the peak of the COVID-19 pandemic. Hawai'i presents a unique epidemiologic context for studying pediatric infections due to its diverse population compared to the continental United States and high proportion of Native Hawaiian and Pacific Islander (NHPI) population with known health disparities.

Objective: The objective of this study was to compare the severity and identify risk factors and clinical outcomes of SAG- and non-SAG-related complicated pediatric head and neck infections in Hawai'i.

Design/Methods: A retrospective chart review was performed on patients under 18 years of age admitted to the only pediatric tertiary care facility in the Pacific Basin from May 2019 to July 2025 with complicated head and neck infections and positive bacterial culture using ICD-10 codes. This study was IRB exempt. Complicated infections were identified as head and neck infections with intracranial abscesses, orbital abscesses, mastoiditis, Pott's Puffy Tumor, septic venous sinus thromboses, retropharyngeal abscesses. Patient demographics, surgeries, and clinical outcomes were analyzed.

Results: We identified 231 patients with complicated head and neck infections. The proportion of NHPI children with complicated head and neck infections were disproportionately higher than their proportion in the general pediatric population (p < 0.0001). There were 35 (15%) SAG and 196 (85%) non-SAG infections. There were no demographic differences between these groups. The proportion of SAG infections increased over six years from 5.6% to 21.1% (p=0.034). ICU admissions were more frequent among SAG cases (31.4% vs 7.8%; aOR 2.8, 95% CI 0.7-10.4). SAG infections were associated with significantly higher rates of intracranial abscess (20.6% vs 8.3%; p=0.02), craniotomy (5.9% vs 0.0%; p=0.0013), sinus surgery (3.2% vs 0.6%; p=0.0011), and multiple surgical procedures (5.9% vs 2.1%; p=0.015).

Conclusion(s): SAG-related complicated pediatric head and neck infections are more severe and continue to increase in frequency years after the COVID-19 pandemic in the unique population in Hawai'i. SAG affected children similarly across racial and socioeconomic backgrounds in the study. The disproportionate number of NHPI children afflicted with complicated head and neck infections compared to the general Hawai'i population underscores the importance of addressing health disparities and improving clinical awareness in this demographic.

Racial composition of the patients with complicated head and neck infections compared to the general pediatric population in Hawai'i
Native Hawaiian and Other Pacific Islander (NHPI) children made up 58.9% of infection cases but only 14.2% of the statewide pediatric population, whereas White (14.6% vs 34.2%) and Asian (23.5% vs 51.1%) children were underrepresented among cases. Differences were statistically significant (χ² test, p < 0.0001).

Rates of SAG infections in Complicated Pediatric Head and Neck Infections
Rates of SAG infections in complicated pediatric head and neck infections from 2019-2025. The proportion of cases caused by the Streptococcus anginosus group (SAG) increased from ~5-6% in 2019-2020 to >20% by 2024-2025, representing a statistically significant upward trend.