A Cluster of Septic Olecranon Bursitis in Association With Infantry Training

Wasserzug, Oshri; Balicer, Ran D.; Boxman, J.; Klement, Eyal; Ambar, Ruhama; Zimhony, Oren

doi:10.7205/milmed-d-10-00117

Cited by 11 publications

(4 citation statements)

References 6 publications

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“…Sporadic and epidemic illness caused by streptococci is a significant public health problem in the Israel Defense Forces (IDF) [9,10]. Pharyngitis and cutaneous outbreaks, several of which are caused by GGS, occur several times a year in combat and other military units.…”

Section: Introductionmentioning

confidence: 99%

Molecular characterization and antibiotic resistance of group G streptococci in Israel: comparison of invasive, non-invasive and carriage isolates

Halperin

Levine

Korenman

et al. 2016

Eur J Clin Microbiol Infect Dis

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Beta-hemolytic group G streptococci (GGS) are increasingly recognized as a source of substantial morbidity, causing mild to severe sporadic infections as well as outbreaks. The purpose of this study was to determine the genetic diversity and antibiotic resistance of GGS in Israel in order to aid in prevention and control. A total of 325 GGS isolates were collected in Israel between 2007 and 2011 from three determined settings: (1) carriage (n = 60), an observational longitudinal carriage study in the IF, (2) non-invasive (n = 166), clinical sporadic and epidemic non-invasive cases in the IDF, and (3) invasive (n = 99) cases of bacteremia collected during this period in Israel from a similar age group, at the national Streptococcal Reference Center. All isolates were characterized genetically and by their antibiotic-resistance profile. emm typing revealed 35 distinct types and subtypes among 228 S. dysgalactiae subsp. equisimilis (SDSE) isolates, with high genetic diversity. An additional 97 GGS were identified as Streptococcus anginosus (SAG). The proportion of SDSE was higher in the invasive (100 %) and non-invasive (63.8 %) isolates compared to the carriage ones (38.3 %). Clindamycin, erythromycin, azithromycin and tetracycline resistance was detected in 6.6 %, 8.6 %, 9.7 % and 37.6 % of isolates, respectively. Overall, the most resistant isolates were in the invasive group and the fewest were in the SAG group. Considerable genetic diversity and common antibiotic resistance were revealed among GGS strains which differed according to the epidemiologic settings. Further clinical, epidemiological and basic research of GGS as a pathogen is warranted.

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Section: Introductionmentioning

confidence: 99%

Molecular characterization and antibiotic resistance of group G streptococci in Israel: comparison of invasive, non-invasive and carriage isolates

Halperin

Levine

Korenman

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…SSTI outbreaks have been reported frequently in the Israel Defense Forces (IDF) over the last decade with attack rates of up to 95 % among groups of infantry trainees [ 12 , 13 ]. This epidemic and sporadic illness has been associated with a high burden of lost training days, significant clinical complications and deaths of infantry trainees in recent years [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Neglect of skin wounds and the risk of becoming a Staphylococcus aureus nasal carrier: a cohort study

et al. 2015

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BackgroundNasal carriers of Staphylococcus aureus have an increased risk of acquiring skin and soft tissue infections, which could manifest as outbreaks, especially in crowded settings. Current prevention programs are ineffective, antibiotic resistance is rising and risk factors for becoming a carrier are incompletely understood. We aimed to examine whether a behavior, the neglect of skin wounds, is a risk factor for becoming a Staphylococcus aureus carrier during training.MethodsWe conducted a field-based cohort study among male infantry trainees in three seasons in Israel during 2011–12. Participants underwent anterior nares cultures and answered structured questionnaires on potential risk factors on two occasions: before and 3 weeks after start of training (N = 542). Attitudes and practices toward neglect of skin wounds were defined as perseverance in training at all costs, despite having a wound. Samples were processed within 18 hours for identification of Staphylococcus aureus. Univariable and multivariable logistic regression analyses were performed to assess risk factors for becoming a carrier.ResultsCarriage prevalence increased by 43.3 % during training, from 33.2 % to 47.6 % (p < 0.01). One-fourth (25.4 %) of those with a negative culture before training became carriers. None of the socio-demographic characteristics was a risk factor for becoming a carrier while the risk was lower in the winter (Odds ratio [OR] = 0.42; 95 % confidence interval [CI]: 0.23-0.78, p < 0.01) and spring (OR = 0.46; 0.26-0.81, p < 0.01) seasons compared to the summer season. Neglect of skin wounds in practice and attitude was a risk factor for becoming a carrier (OR = 2.40; 1.13-5.12, p = 0.02), as well as neglect in practice or attitude (OR = 1.86; 1.04-3.34, p = 0.04) compared to no neglect when controlled for season. The preventable fraction in the population attributed to neglect of skin wounds was 33 %.ConclusionsNeglect of skin wounds is an independent, common and strong risk factor for becoming a Staphylococcus aureus carrier during training. This preventable behavior should not be ignored and should be addressed in public health programs during training and in other settings. Further research on behavioral determinants of Staphylococcus aureus carriage and infection is warranted.

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“…Olecranon bursitis can be classified as aseptic (chronic) and septic (acute). Aseptic olecranon bursitis is more common and is usually a result of repeated, low intensity trauma to the elbow as seen in miners, students, carpet-layers, book-keepers and gymnasts [3] [4]. Other rarer causes include systemic inflammatory processes like rheumatoid arthritis, gout, systemic lupus erythematosus and pigmented villonodular synovitis.…”

Section: Discussionmentioning

confidence: 99%