Nursing home outbreak of invasive group a streptococcal infections caused by 2 distinct strains.

Abstract:

OBJECTIVE:To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases. DESIGN:Outbreak investigation. SETTING:A 146-bed nursing home facility in northern Nevada. METHODS:We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices. RESULTS:Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts. CONCLUSIONS:Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.

authors

Thigpen MC,Thomas DM,Gloss D,Park SY,Khan AJ,Fogelman VL,Beall B,Van Beneden CA,Todd RL,Greene CM

doi

10.1086/508821

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

68-74

issue

1

eissn

0899-823X

issn

1559-6834

pii

ICHE2005329

journal_volume

28

pub_type

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