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- Title
Surveillance for hospital outbreaks of invasive group a streptococcal infections in Ontario, Canada, 1992 to 2000.
- Authors
Daneman N; Green KA; Low DE; Simor AE; Willey B; Schwartz B; Toye B; Jessamine P; Tyrrell GJ; Krajden S; Ramage L; Rose D; Schertzberg R; Bragg D; McGeer A; Ontario Group A Streptococcal Study Group; Daneman, Nick; Green, Karen A; Low, Donald E; Simor, Andrew E
- Abstract
<bold>Background: </bold>Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks.<bold>Objective: </bold>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.<bold>Design: </bold>Prospective, population-based surveillance.<bold>Setting: </bold>Short-term care hospitals in Ontario, Canada.<bold>Patients: </bold>Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000.<bold>Measurements: </bold>Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission.<bold>Results: </bold>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.<bold>Limitations: </bold>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.<bold>Conclusions: </bold>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.
- Publication
Annals of Internal Medicine, 2007, Vol 147, Issue 4, p234
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-147-4-200708210-00004