This report reviews 45 episodes of group A streptococcal bacteremia during 1980-1989 in a large hospital; 24 episodes occurred in the first 5 years of study (1980-1984) and 21 in the last 5 years (1985-1989). Four episodes were nosocomial. The remaining 41 episodes were community acquired; of these episodes, 12 occurred in patients who were transferred from nursing homes. There was a definite seasonal predominance (84%) during November-June. All but three patients had chronic underlying conditions. The major portals of entry were the skin and lungs, and the main types of infection were primary septicemia, cellulitis and soft-tissue infection, pneumonia, and infective endocarditis. The overall mortality rate was 24%; 20% of the deaths were due to infection. Factors that adversely influenced mortality were septic shock (P less than .02), less than 10,000/mm3 leukocytes (P less than .05); less than 80% segmented polymorphonuclear leukocytes and band forms (P less than .02), and hyperbilirubinemia (P less than .01). Neither prevalence nor severity of group A streptococcal bacteremia increased during the last 5 years of study.