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Nursing Home Outbreak of Invasive Group A Streptococcal Infections Caused by 2 Distinct Strains

Published online by Cambridge University Press:  17 August 2016

Michael C. Thigpen ,
D. Michael Thomas ,
David Gloss ,
Sarah Y. Park ,
Amy J. Khan ,
Vicky L. Fogelman ,
Bernard Beali ,
Chris A. Van Beneden ,
Randall L. Todd  and
Carolyn M. Greene
Michael C. Thigpen*
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia
D. Michael Thomas
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
David Gloss
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Sarah Y. Park
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia
Amy J. Khan
Affiliation:
Career Epidemiology Field Officer, Division of Public Health Partnerships, National Center for Health Marketing, Atlanta, Georgia Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
Vicky L. Fogelman
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
Bernard Beali
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Chris A. Van Beneden
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Randall L. Todd
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
Carolyn M. Greene
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
*
1600 Clifton Rd., Mailstop E-45, Atlanta, GA 30333 (mthigpen@cdc.gov)
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 1 , January 2007 , pp. 68 - 74
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs) report, emerging infections program network: group A streptococcus 1998-2003. Available at: http://www.cdc.gov/ncidod/dbmd/abcs/survreports.htm. Accessed September 7, 2004.Google Scholar
2. Bamham, M, Kerby, J. Streptococcus pyogenes pneumonia in residential homes: probable spread of infection from the staff. J Hosp Infect 1981;2:255–257.Google Scholar
3. Centers for Disease Control and Prevention. Epidemiologic notes and reports nursing home outbreaks of invasive group A streptococcal infections—Illinois, Kansas, North Carolina, and Texas. MMWR Morb Mortal Wkly Rep 1990;39:577–579.Google Scholar
4. Auerbach, SB, Schwartz, B, Williams, D, et al. Outbreak of invasive group A streptococcal infections in a nursing home: lessons on prevention and control. Arch Intern Med 1992;152:1017–1022.Google Scholar
5. Harkness, GA, Bentley, DW, Mottley, M, Lee, J. Streptococcus pyogenes outbreak in a long-term care facility. Am J Infect Control 1992;20:142–148.Google Scholar
6. Schwartz, B, Ussery, XT. Group A streptococcal outbreaks in nursing homes. Infect Control Hosp Epidemiol 1992;13:742–747.CrossRefGoogle Scholar
7. Schwartz, B, Elliott, JA, Butler, JC, et al. Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings. Clin Infect Dis 1992;15:277–284.Google Scholar
8. Ridgway, EJ, Allen, KD. Clustering of group A streptococcal infections on a burns unit: important lesions in outbreak management. J Hosp Infect 1993;25:173–182.Google Scholar
9. Gunzenhauser, JD, Longfield, JN, Brundage, JF, Kaplan, EL, Miller, RN, Brandt, CA. Epidemic streptococcal disease among Army trainees, July 1989 through June 1991. J Infect Dis 1995;172:124–131.Google Scholar
10. Centers for Disease Control and Prevention. Outbreak of group A streptococcal pneumonia among Marine Corps recruits—California, November 1-December 20, 2002. MMWR Morb Mortal Wkly Rep 2003;52:106–109.Google Scholar
11. Centers for Disease Control and Prevention. Protocol for emm Typing. Atlanta, GA: Department of Health and Human Services; 2006. Available at: http://www.cdc.gov/ncidod/biotech/strep/protocol_emm-type.htm. Accessed December 2, 2006.Google Scholar
12. Espinosa, LE, Li, Z, Gomez Barreto, D, et al. M protein gene type distribution among group A streptococcal clinical isolates recovered in Mexico City, Mexico, from 1991 to 2000, and Durango, Mexico, from 1998 to 1999: overlap with type distribution within the United States. J Clin Microbiol 2003;41:373–378.Google Scholar
13. Centers for Disease Control and Prevention. Streptococcus pyogenes emm sequence database. Available at: http://www.cdc.gov/ncidod/biotech/strep/strepindex.htm. Accessed November 22, 2004.Google Scholar
14. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2003;52(RR-8):1–34.Google Scholar
15. Davies, HD, McGeer, A, Schwartz, B, et al. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med 1996;335:547–554.CrossRefGoogle ScholarPubMed
16. Schwartzmann, SW, Adler, JL, Sullivan, RFJ, Marine, WM. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969. Arch Intern Med 1971;127:1037–1041.CrossRefGoogle Scholar
17. Muller, MP, Low, DE, Green, KA, et al. Clinical and epidemiologic features of group A streptococcal pneumonia in Ontario, Canada. Arch Intern Med 2003;163:467–472.CrossRefGoogle Scholar
18. Centers for Disease Control and Prevention. Respiratory hygiene/cough etiquette in healthcare settings. Available at: http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm. Accessed on November 23, 2004.Google Scholar
19. The Prevention of Invasive Group A Streptococcal Infections Workshop participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950–959.Google Scholar