TY - JOUR
T1 - Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000
AU - Daneman, Nick
AU - Green, Karen A.
AU - Low, Donald E.
AU - Simor, Andrew E.
AU - Willey, Barbara
AU - Schwartz, Benjamin
AU - Toye, Baldwin
AU - Jessamine, Peter
AU - Tyrrell, Gregory J.
AU - Krajden, Sigmund
AU - Ramage, Lee
AU - Rose, David
AU - Schertzberg, Ruth
AU - Bragg, Delena
AU - McGeer, Allison
AU - Loeb, Mark
AU - Gregson, Daniel
AU - Davies, H. Dele
AU - John, Michael
AU - Saginur, Raphael
AU - Demers, Brigitte
AU - Kaul, Rupert
AU - Talbot, James
AU - Lovgren, Marguerite
AU - Mederski, Barbara
AU - Sarabia, Alicia
AU - Trpeski, Lilijana
AU - Cann, Darlene
AU - Plevneshi, Agron
AU - McArthur, Margaret
AU - Fletcher, Aileen
AU - Walmsley, Sharon
AU - Gold, Wayne
PY - 2007/8/21
Y1 - 2007/8/21
N2 - Background: Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks. Objective: To describe the epidemiology of hospital outbreaks of invasive group A streptococcal infection in order to understand the potential benefit of proposed outbreak investigation and management strategies. Design: Prospective, population-based surveillance. Setting: Short-term care hospitals in Ontario, Canada. Patients: Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000. Measurements: Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission. Results: Of 2351 cases of invasive group A streptococcal disease, 291 (12%) were hospital acquired. Twenty-nine (10%) nosocomial cases occurred as part of 20 outbreaks. Seventy percent (14 of 20) of outbreaks involved nonsurgical, nonobstetric patients. Community-acquired cases initiated 25% of outbreaks; most were cases of necrotizing fasciitis in patients admitted to the intensive care unit. Outbreaks were small (median, 2 cases [range, 2 to 10 cases]) and short (median duration, 6 days [range, 0 to 30 days]). The median time between the first 2 cases was 4.5 days. The most common mode of propagation was patient-to-patient transmission. A staff carrier was the primary mode of transmission in 2 (10%) outbreaks, but 1 or more health care workers were colonized with the outbreak strain in 6 of 18 (33%) other outbreaks. Limitations: Some outbreaks with 1 case of invasive disease may have been missed; advice provided to participating hospitals may have reduced the number and size of outbreaks. Conclusions: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards.
AB - Background: Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks. Objective: To describe the epidemiology of hospital outbreaks of invasive group A streptococcal infection in order to understand the potential benefit of proposed outbreak investigation and management strategies. Design: Prospective, population-based surveillance. Setting: Short-term care hospitals in Ontario, Canada. Patients: Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000. Measurements: Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission. Results: Of 2351 cases of invasive group A streptococcal disease, 291 (12%) were hospital acquired. Twenty-nine (10%) nosocomial cases occurred as part of 20 outbreaks. Seventy percent (14 of 20) of outbreaks involved nonsurgical, nonobstetric patients. Community-acquired cases initiated 25% of outbreaks; most were cases of necrotizing fasciitis in patients admitted to the intensive care unit. Outbreaks were small (median, 2 cases [range, 2 to 10 cases]) and short (median duration, 6 days [range, 0 to 30 days]). The median time between the first 2 cases was 4.5 days. The most common mode of propagation was patient-to-patient transmission. A staff carrier was the primary mode of transmission in 2 (10%) outbreaks, but 1 or more health care workers were colonized with the outbreak strain in 6 of 18 (33%) other outbreaks. Limitations: Some outbreaks with 1 case of invasive disease may have been missed; advice provided to participating hospitals may have reduced the number and size of outbreaks. Conclusions: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards.
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U2 - 10.7326/0003-4819-147-4-200708210-00004
DO - 10.7326/0003-4819-147-4-200708210-00004
M3 - Article
C2 - 17709757
AN - SCOPUS:34548385636
VL - 147
SP - 234
EP - 241
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 4
ER -