A Maternal-Neonatal Outbreak of Infections Due to an Unusual Group A β-Hemolytic Streptococcus

Abstract

An outbreak of group A β-hemolytic streptococcal infections involving three parturients, three newborns, and a nursery RN is reported. Six of six organisms available for serotyping were M-untypable, T-11, serum opacity reaction-negative. Propagation of the outbreak may have been fostered by the common use of a single sitz bath, although the evidence to support this is weak. The outbreak was rapidly controlled via strict cohorting, appropriate treatment and isolation of cases, and the routine use of triple dye for umbilical cord care.

Sitz Bath: Where Is the Evidence? Scientific Basis of a Common Practice

“…Only six articles have been published addressing this topic. [22][23][24][25][26][27] Skin burns can be prevented by avoiding high water temperature and by limiting the duration of the sitz bath. [25][26][27] Even though no scientific evidence is available to indicate that sitz bath can promote faster healing or offer reduction in postoperative complications, it is probably frequently recommended because of the low morbidity it carries.…”

“…Six articles reported the potential complications of sitz bath, [22][23][24][25][26][27] including three that addressed infectious complications. [22][23][24] Chang reported two female patients with genital herpes outbreaks who were advised to undergo multiple sitz baths a day.…”

“…[22][23][24] Chang reported two female patients with genital herpes outbreaks who were advised to undergo multiple sitz baths a day. 22 Both patients suffered from progression of their disease to additional skin areas.…”

“…Three postpartum women along with their three newborns suffered from the infection in the hospital after using a common sitz bath setup. 23 DeGroot investigated the possibility of sitz baths contributing to bacteriuria. 24 Elderly women with and without a Foley ® catheter (Bard Urological Co., Covington, CA) performed sitz bath consisting of dye mixed with the water.…”

Provider Knowledge, Attitudes, and Practices regarding Obstetric and Postsurgical Gynecologic Infections Due to Group AStreptococcusand Other Infectious Agents

“…The source of a sporadic postpartum GAS infection is typically unknown, but outbreaks of postpartum and postsurgical GAS infections have been associated with colonized healthcare workers. Healthcare workers who were asymptomatic carriers of GAS have been identified in 15 of 21 outbreaks of postpartum and postsurgical infections reported from 1976 through 2005 [6–26]; these infections represent a preventable manifestation of severe GAS disease.…”