Regev Cohen1, Shoshana Cohen2, Marina Afraimov2, Talya Finn3, Frida Babushkin2, Keren Geller2, Svetlana Paikin4, Irena Yoffe5, Lea Valinsky6, Merav Ron6, Assaf Rokney6. 1. Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion Medicine, Haifa, Israel. Electronic address: regevco@gmail.com. 2. Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel. 3. Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion Medicine, Haifa, Israel. 4. Microbiology Laboratory, Sanz Medical Center, Laniado Hospital, Netanya, Israel. 5. Hematology Ward, Sanz Medical Center, Laniado Hospital, Netanya, Israel. 6. Central Laboratories, Ministry of Health, Jerusalem, Israel.
Abstract
BACKGROUND: Invasive group A streptococcal (iGAS) infection in the peripartum setting is a rare but devastating disease occasionally occurring as a health care-associated infection (HAI). Current guidelines suggest enhanced surveillance and streptococcal isolate storage after a single case of iGAS, as well as a full epidemiological investigation that includes screening health care workers (HCWs) from several sites after 2 cases. Current guidelines do not recommend routine screening of household members of a patient with iGAS. METHODS: We conducted studies of 3 patients with iGAS puerperal sepsis and related epidemiologic and molecular investigations. RESULTS: Identical GAS emm gene types were found in pharyngeal cultures of 3 asymptomatic spouses of patients with iGAS puerperal sepsis. HCWs screened negative for GAS, and emm typing indicated that other iGAS cases from this hospital were sporadic and not related to the puerperal cases. CONCLUSIONS: The concurrent presence of the same emm type in a household member practically excludes the option of an inadvertent HAI or facility outbreak. Hence, we suggest that screening close family members for asymptomatic GAS carriage should be performed early as a part of infection prevention measures, as doing so would have significant utility in saving time and resources related to a full epidemiological inquiry.
BACKGROUND: Invasive group A streptococcal (iGAS) infection in the peripartum setting is a rare but devastating disease occasionally occurring as a health care-associated infection (HAI). Current guidelines suggest enhanced surveillance and streptococcal isolate storage after a single case of iGAS, as well as a full epidemiological investigation that includes screening health care workers (HCWs) from several sites after 2 cases. Current guidelines do not recommend routine screening of household members of a patient with iGAS. METHODS: We conducted studies of 3 patients with iGAS puerperal sepsis and related epidemiologic and molecular investigations. RESULTS: Identical GAS emm gene types were found in pharyngeal cultures of 3 asymptomatic spouses of patients with iGAS puerperal sepsis. HCWs screened negative for GAS, and emm typing indicated that other iGAS cases from this hospital were sporadic and not related to the puerperal cases. CONCLUSIONS: The concurrent presence of the same emm type in a household member practically excludes the option of an inadvertent HAI or facility outbreak. Hence, we suggest that screening close family members for asymptomatic GAS carriage should be performed early as a part of infection prevention measures, as doing so would have significant utility in saving time and resources related to a full epidemiological inquiry.