A 7-Month Outbreak of Relapsing Postpartum Group A Streptococcal Infections Linked to a Nurse with Atopic Dermatitis

Abstract

A 7-month outbreak of 15 cases of postpartum sepsis with group A haemolytic Streptococci (GAS) was stopped when a carrier was identified. Comparing delivery dates with duty rotas revealed that the carrier had been present during delivery in 13 of the 15 cases. The epidemic GAS type, T3-13-B3264, was found in a carbuncle in her groin and in atopic dermatitis lesions behind her ears and on her eyelids. Thus, it was not the microbiological screening of staff that helped detect the carrier. The outbreak went unnoticed for 6 months, as no 2 cases were diagnosed by the same physician and 5 cases were diagnosed by different general practitioners. The main risk factors for infection were presence of the carrier relative risk (relative risk RR 47.8, 95% confidence interval (CI) 10.9-209.5) and suturing of episiotomy (RR 11.0; 95% CI 2.6-47.9). We recommend that a thorough epidemiological investigation should be carried out in every single case of GAS postpartum infection. Despite initial intravenous treatment with penicillin, 8 patients experienced > 15 recurring postpartum GAS infections, such as endometritis, wound infection, tonsillitis, erysipelas and Brodie's abscess. Eradication of GAS should be confirmed after completion of treatment.

Microbiological investigation of a hospital outbreak of invasive group A streptococcal disease in Krakow, Poland

“…Most have been related to the spread of GAS among post-partum patients by healthcare workers who are asymptomatic carriers [4][5][6]. This epidemiological picture was also seen in the outbreak reported in the present study.…”

“…In hospitals, person-to-person spread of GAS infection occurs via respiratory droplets and by direct contact. There are reports of outbreaks of post-partum GAS infection related to the spread of GAS from healthcare personnel to patients [3][4][5][6].…”

Group A Streptococcal Toxic Shock Syndrome Developing inthe Third Trimester of Pregnancy

“…Definite cases of GAS TSS in the intrapartum or puerperium reported since 1990 in the English literature located by a MEDLINE search (using the terms 'group A streptococci', 'Streptococcus pyogenes', 'shock', 'pregnancy', and 'puerperal') are shown in Table 1 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . Most GAS puerperal cases occur sporadically with the patients' endogenous flora; however, outbreaks have been reported due to nosocomial spread and require prompt isolation and identification of the source of the infection [26][27][28][29] .…”

Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy

“…An example of this includes injection sites, cesarean section, plastic surgery and even minor cosmetic procedures [37][38][39][40][41][42][43]. Where nosocomial GAS NF is suspected or if there is a cluster of cases, the source may prove to be a member of the hospital staff [44][45][46].…”

“…Massive amounts of enzymes, hemolysins, DNAase, protease and collagenase are produced by streptococci embedded in tissues, which allow spreading of the streptococci to undermine normal skin with progressive coagulation necrosis. In addition, streptokinase produces clotting abnormalities [46][47][48][49].…”