BACKGROUND: Invasive group A streptococcus (GAS) affects approximately 10,500 persons annually; 1 in 5 patients >/=65 years die. In August 2001, CDC investigated a cluster of GAS deaths in a Georgia long-term care facility (LTCF). METHODS: We screened LTCF residents and staff for GAS carriage and conducted a retrospective cohort study among residents. We defined a case as GAS isolation associated with clinical infection. RESULTS: Eight cases were identified (median age: 79 years); 6 (75%) patients died. Carriage was similar in residents (10%) and staff (9%). All isolates among residents and 63% among staff were type emm 77. Risk factors for GAS disease or carriage among residents were receiving skin treatment (relative risk [RR] = 4.0, 95% confidence interval [CI] = 1.9-11.0) and having an infected or colonized roommate (RR = 2.0, 95% CI = 1.10-5.0). No wound care nurse carried GAS. Interventions included education about standardized infection control guidelines and appropriate hand hygiene; carriers were treated with antibiotics. No subsequent GAS cases were identified in the following year. CONCLUSIONS: Transmission of GAS in this outbreak likely occurred during wound care and ended with improved hand hygiene. This investigation highlights additional research and policy needs for control of severe GAS infections among the high-risk LTCF population.
BACKGROUND: Invasive group A streptococcus (GAS) affects approximately 10,500 persons annually; 1 in 5 patients >/=65 years die. In August 2001, CDC investigated a cluster of GAS deaths in a Georgia long-term care facility (LTCF). METHODS: We screened LTCF residents and staff for GAS carriage and conducted a retrospective cohort study among residents. We defined a case as GAS isolation associated with clinical infection. RESULTS: Eight cases were identified (median age: 79 years); 6 (75%) patients died. Carriage was similar in residents (10%) and staff (9%). All isolates among residents and 63% among staff were type emm 77. Risk factors for GAS disease or carriage among residents were receiving skin treatment (relative risk [RR] = 4.0, 95% confidence interval [CI] = 1.9-11.0) and having an infected or colonized roommate (RR = 2.0, 95% CI = 1.10-5.0). No wound care nurse carried GAS. Interventions included education about standardized infection control guidelines and appropriate hand hygiene; carriers were treated with antibiotics. No subsequent GAS cases were identified in the following year. CONCLUSIONS: Transmission of GAS in this outbreak likely occurred during wound care and ended with improved hand hygiene. This investigation highlights additional research and policy needs for control of severe GAS infections among the high-risk LTCF population.
Authors: Miwako Kobayashi; Meghan M Lyman; Louise K Francois Watkins; Karrie-Ann Toews; Leon Bullard; Rachel A Radcliffe; Bernard Beall; Gayle Langley; Chris Van Beneden; Nimalie D Stone Journal: J Am Geriatr Soc Date: 2016-11-07 Impact factor: 5.562
Authors: Philip W Smith; Gail Bennett; Suzanne Bradley; Paul Drinka; Ebbing Lautenbach; James Marx; Lona Mody; Lindsay Nicolle; Kurt Stevenson Journal: Infect Control Hosp Epidemiol Date: 2008-09 Impact factor: 3.254
Authors: Michael C Thigpen; Chesley L Richards; Ruth Lynfield; Nancy L Barrett; Lee H Harrison; Kathryn E Arnold; Arthur Reingold; Nancy M Bennett; Allen S Craig; Ken Gershman; Paul R Cieslak; Paige Lewis; Carolyn M Greene; Bernard Beall; Chris A Van Beneden Journal: Emerg Infect Dis Date: 2007-12 Impact factor: 6.883
Authors: Philip W Smith; Gail Bennett; Suzanne Bradley; Paul Drinka; Ebbing Lautenbach; James Marx; Lona Mody; Lindsay Nicolle; Kurt Stevenson Journal: Am J Infect Control Date: 2008-09 Impact factor: 2.918
Authors: Jean Rainbow; Brenda Jewell; Richard N Danila; David Boxrud; Bernard Beall; Chris Van Beneden; Ruth Lynfield Journal: Emerg Infect Dis Date: 2008-05 Impact factor: 6.883
Authors: Victoria J Chalker; Alyson Smith; Ali Al-Shahib; Stella Botchway; Emily Macdonald; Roger Daniel; Sarah Phillips; Steven Platt; Michel Doumith; Rediat Tewolde; Juliana Coelho; Keith A Jolley; Anthony Underwood; Noel D McCarthy Journal: Emerg Infect Dis Date: 2016-06 Impact factor: 6.883