Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK

Steer, Jane A.; Lamagni, Theresa; Healy, Brendan; Morgan, Marina S.; Dryden, Matthew; Rao, Bhargavi; Sriskandan, Shiranee; George, Robert C.; Efstratiou, Androulla; Baker, F. W.; Baker, Alex; Marsden, Doreen; Murphy, Elizabeth A.; Fry, Carole; Irvine, Neil; Hughes, Rhona; Wade, Paul; Cordery, Rebecca; Cummins, Amelia; Oliver, Isabel; Jokinen, Mervi; McMenamin, Jim; Kearney, Joe

doi:10.1016/j.jinf.2011.11.001

Cited by 71 publications

(76 citation statements)

References 60 publications

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“…Previous outbreaks have been associated with HCWs asymptomatically carrying GAS at all mucosal sites (11); therefore, we cannot fully exclude an unknown HCW source of GAS. HCW compliance is essential during outbreak investigation (13, 23), and newly issued United Kingdom guidance (14) recommends that nasal, rectal, and vaginal swabs should be obtained, if other swabs are negative, in situations where an HCW is implicated in transmission.…”

Section: Discussionmentioning

confidence: 99%

Molecular Analysis of an Outbreak of Lethal Postpartum Sepsis Caused by Streptococcus pyogenes

et al. 2013

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Sepsis is now the leading direct cause of maternal death in the United Kingdom, and Streptococcus pyogenes is the leading pathogen. We combined conventional and genomic analyses to define the duration and scale of a lethal outbreak. Two postpartum deaths caused by S. pyogenes occurred within 24 h; one was characterized by bacteremia and shock and the other by hemorrhagic pneumonia. The women gave birth within minutes of each other in the same maternity unit 2 days earlier. Seven additional infections in health care and household contacts were subsequently detected and treated. All cluster-associated S. pyogenes isolates were genotype emm1 and were initially indistinguishable from other United Kingdom emm1 isolates. Sequencing of the virulence gene sic revealed that all outbreak isolates had the same unique sic type. Genome sequencing confirmed that the cluster was caused by a unique S. pyogenes clone. Transmission between patients occurred on a single day and was associated with casual contact only. A single isolate from one patient demonstrated a sequence change in sic consistent with longer infection duration. Transmission to health care workers was traced to single clinical contacts with index cases. The last case was detected 18 days after the first case. Following enhanced surveillance, the outbreak isolate was not detected again. Mutations in bacterial regulatory genes played no detectable role in this outbreak, illustrating the intrinsic ability of emm1 S. pyogenes to spread while retaining virulence. This fast-moving outbreak highlights the potential of S. pyogenes to cause a range of diseases in the puerperium with rapid transmission, underlining the importance of immediate recognition and response by clinical infection and occupational health teams.

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Section: Discussionmentioning

confidence: 99%

Molecular Analysis of an Outbreak of Lethal Postpartum Sepsis Caused by Streptococcus pyogenes

et al. 2013

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“…GAS transmit directly [3], but are also shed into the environment where they remain viable for months, and shedding of large numbers of bacteria is associated with high nasal bacterial load [37,38]. These fomites do not seem to give rise to pharyngitis, however, at least not when dry, but can result in other infections [39][40][41][42][43].…”

Section: Why Are There Two Adaptive Types Of Infection?mentioning

confidence: 99%

To harm or not to harm? On the evolution and expression of virulence in group A streptococci

Waldetoft

Råberg

2014

Trends in Microbiology

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“…Given the nature of the duties performed by these nurses and the vulnerability of their patients, this would have potentially led to further cases of iGAS. Furthermore, GAS can colonise many body sites with hospital outbreaks linked to anal and vaginal carriage (Steer et al, 2012b), sites which are not routinely swabbed.…”

Section: Discussionmentioning

confidence: 99%

An outbreak of invasive group A streptococcal infection among elderly patients receiving care from a district nursing team, October 2013 – May 2014

Olufon

Iyanger

Cleary

et al. 2015

Journal of Infection Prevention

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Between October 2013 and April 2014 five elderly patients living within a 2 square mile radius, were admitted to local hospitals with severe group A streptococcal cellulitis and septicaemia. Molecular typing confirmed four patients for whom typing results were available to have the same emm gene sequence type, emm st89. An outbreak investigation was launched and identified that each patient had received care interventions from a district nursing team at their home or local health clinic in the 7 days prior to onset of symptoms.

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Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK

Cited by 71 publications

References 60 publications

Molecular Analysis of an Outbreak of Lethal Postpartum Sepsis Caused by Streptococcus pyogenes

Molecular Analysis of an Outbreak of Lethal Postpartum Sepsis Caused by Streptococcus pyogenes

To harm or not to harm? On the evolution and expression of virulence in group A streptococci

An outbreak of invasive group A streptococcal infection among elderly patients receiving care from a district nursing team, October 2013 – May 2014

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