Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000

Nick Daneman, Karen A. Green, Donald E. Low, Andrew E. Simor, Barbara Willey, Benjamin Schwartz, Baldwin Toye, Peter Jessamine, Gregory J. Tyrrell, Sigmund Krajden, Lee Ramage, David Rose, Ruth Schertzberg, Delena Bragg, Allison McGeer, Mark Loeb, Daniel Gregson, Herbert Dele Davies, Michael John, Raphael Saginur & 13 others Brigitte Demers, Rupert Kaul, James Talbot, Marguerite Lovgren, Barbara Mederski, Alicia Sarabia, Lilijana Trpeski, Darlene Cann, Agron Plevneshi, Margaret McArthur, Aileen Fletcher, Sharon Walmsley, Wayne Gold

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks. Objective: To describe the epidemiology of hospital outbreaks of invasive group A streptococcal infection in order to understand the potential benefit of proposed outbreak investigation and management strategies. Design: Prospective, population-based surveillance. Setting: Short-term care hospitals in Ontario, Canada. Patients: Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000. Measurements: Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission. Results: Of 2351 cases of invasive group A streptococcal disease, 291 (12%) were hospital acquired. Twenty-nine (10%) nosocomial cases occurred as part of 20 outbreaks. Seventy percent (14 of 20) of outbreaks involved nonsurgical, nonobstetric patients. Community-acquired cases initiated 25% of outbreaks; most were cases of necrotizing fasciitis in patients admitted to the intensive care unit. Outbreaks were small (median, 2 cases [range, 2 to 10 cases]) and short (median duration, 6 days [range, 0 to 30 days]). The median time between the first 2 cases was 4.5 days. The most common mode of propagation was patient-to-patient transmission. A staff carrier was the primary mode of transmission in 2 (10%) outbreaks, but 1 or more health care workers were colonized with the outbreak strain in 6 of 18 (33%) other outbreaks. Limitations: Some outbreaks with 1 case of invasive disease may have been missed; advice provided to participating hospitals may have reduced the number and size of outbreaks. Conclusions: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards.

Original languageEnglish (US)
Pages (from-to)234-241
Number of pages8
JournalAnnals of internal medicine
Volume147
Issue number4
DOIs
StatePublished - Aug 21 2007

Fingerprint

Streptococcal Infections
Ontario
Canada
Disease Outbreaks
Necrotizing Fasciitis
Streptococcus
Intensive Care Units
Population Surveillance
Patient Isolation
Delivery of Health Care
Streptococcus pyogenes
Obstetrics
Epidemiology

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000. / Daneman, Nick; Green, Karen A.; Low, Donald E.; Simor, Andrew E.; Willey, Barbara; Schwartz, Benjamin; Toye, Baldwin; Jessamine, Peter; Tyrrell, Gregory J.; Krajden, Sigmund; Ramage, Lee; Rose, David; Schertzberg, Ruth; Bragg, Delena; McGeer, Allison; Loeb, Mark; Gregson, Daniel; Davies, Herbert Dele; John, Michael; Saginur, Raphael; Demers, Brigitte; Kaul, Rupert; Talbot, James; Lovgren, Marguerite; Mederski, Barbara; Sarabia, Alicia; Trpeski, Lilijana; Cann, Darlene; Plevneshi, Agron; McArthur, Margaret; Fletcher, Aileen; Walmsley, Sharon; Gold, Wayne.

In: Annals of internal medicine, Vol. 147, No. 4, 21.08.2007, p. 234-241.

Research output: Contribution to journalArticle

Daneman, N, Green, KA, Low, DE, Simor, AE, Willey, B, Schwartz, B, Toye, B, Jessamine, P, Tyrrell, GJ, Krajden, S, Ramage, L, Rose, D, Schertzberg, R, Bragg, D, McGeer, A, Loeb, M, Gregson, D, Davies, HD, John, M, Saginur, R, Demers, B, Kaul, R, Talbot, J, Lovgren, M, Mederski, B, Sarabia, A, Trpeski, L, Cann, D, Plevneshi, A, McArthur, M, Fletcher, A, Walmsley, S & Gold, W 2007, 'Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000', Annals of internal medicine, vol. 147, no. 4, pp. 234-241. https://doi.org/10.7326/0003-4819-147-4-200708210-00004
Daneman, Nick ; Green, Karen A. ; Low, Donald E. ; Simor, Andrew E. ; Willey, Barbara ; Schwartz, Benjamin ; Toye, Baldwin ; Jessamine, Peter ; Tyrrell, Gregory J. ; Krajden, Sigmund ; Ramage, Lee ; Rose, David ; Schertzberg, Ruth ; Bragg, Delena ; McGeer, Allison ; Loeb, Mark ; Gregson, Daniel ; Davies, Herbert Dele ; John, Michael ; Saginur, Raphael ; Demers, Brigitte ; Kaul, Rupert ; Talbot, James ; Lovgren, Marguerite ; Mederski, Barbara ; Sarabia, Alicia ; Trpeski, Lilijana ; Cann, Darlene ; Plevneshi, Agron ; McArthur, Margaret ; Fletcher, Aileen ; Walmsley, Sharon ; Gold, Wayne. / Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000. In: Annals of internal medicine. 2007 ; Vol. 147, No. 4. pp. 234-241.
@article{bad3c5258fed4d8bbc7e9a4a2f204eb1,
title = "Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000",
abstract = "Background: Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks. Objective: To describe the epidemiology of hospital outbreaks of invasive group A streptococcal infection in order to understand the potential benefit of proposed outbreak investigation and management strategies. Design: Prospective, population-based surveillance. Setting: Short-term care hospitals in Ontario, Canada. Patients: Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000. Measurements: Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission. Results: Of 2351 cases of invasive group A streptococcal disease, 291 (12{\%}) were hospital acquired. Twenty-nine (10{\%}) nosocomial cases occurred as part of 20 outbreaks. Seventy percent (14 of 20) of outbreaks involved nonsurgical, nonobstetric patients. Community-acquired cases initiated 25{\%} of outbreaks; most were cases of necrotizing fasciitis in patients admitted to the intensive care unit. Outbreaks were small (median, 2 cases [range, 2 to 10 cases]) and short (median duration, 6 days [range, 0 to 30 days]). The median time between the first 2 cases was 4.5 days. The most common mode of propagation was patient-to-patient transmission. A staff carrier was the primary mode of transmission in 2 (10{\%}) outbreaks, but 1 or more health care workers were colonized with the outbreak strain in 6 of 18 (33{\%}) other outbreaks. Limitations: Some outbreaks with 1 case of invasive disease may have been missed; advice provided to participating hospitals may have reduced the number and size of outbreaks. Conclusions: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards.",
author = "Nick Daneman and Green, {Karen A.} and Low, {Donald E.} and Simor, {Andrew E.} and Barbara Willey and Benjamin Schwartz and Baldwin Toye and Peter Jessamine and Tyrrell, {Gregory J.} and Sigmund Krajden and Lee Ramage and David Rose and Ruth Schertzberg and Delena Bragg and Allison McGeer and Mark Loeb and Daniel Gregson and Davies, {Herbert Dele} and Michael John and Raphael Saginur and Brigitte Demers and Rupert Kaul and James Talbot and Marguerite Lovgren and Barbara Mederski and Alicia Sarabia and Lilijana Trpeski and Darlene Cann and Agron Plevneshi and Margaret McArthur and Aileen Fletcher and Sharon Walmsley and Wayne Gold",
year = "2007",
month = "8",
day = "21",
doi = "10.7326/0003-4819-147-4-200708210-00004",
language = "English (US)",
volume = "147",
pages = "234--241",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "4",

}

TY - JOUR

T1 - Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000

AU - Daneman, Nick

AU - Green, Karen A.

AU - Low, Donald E.

AU - Simor, Andrew E.

AU - Willey, Barbara

AU - Schwartz, Benjamin

AU - Toye, Baldwin

AU - Jessamine, Peter

AU - Tyrrell, Gregory J.

AU - Krajden, Sigmund

AU - Ramage, Lee

AU - Rose, David

AU - Schertzberg, Ruth

AU - Bragg, Delena

AU - McGeer, Allison

AU - Loeb, Mark

AU - Gregson, Daniel

AU - Davies, Herbert Dele

AU - John, Michael

AU - Saginur, Raphael

AU - Demers, Brigitte

AU - Kaul, Rupert

AU - Talbot, James

AU - Lovgren, Marguerite

AU - Mederski, Barbara

AU - Sarabia, Alicia

AU - Trpeski, Lilijana

AU - Cann, Darlene

AU - Plevneshi, Agron

AU - McArthur, Margaret

AU - Fletcher, Aileen

AU - Walmsley, Sharon

AU - Gold, Wayne

PY - 2007/8/21

Y1 - 2007/8/21

N2 - Background: Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks. Objective: To describe the epidemiology of hospital outbreaks of invasive group A streptococcal infection in order to understand the potential benefit of proposed outbreak investigation and management strategies. Design: Prospective, population-based surveillance. Setting: Short-term care hospitals in Ontario, Canada. Patients: Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000. Measurements: Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission. Results: Of 2351 cases of invasive group A streptococcal disease, 291 (12%) were hospital acquired. Twenty-nine (10%) nosocomial cases occurred as part of 20 outbreaks. Seventy percent (14 of 20) of outbreaks involved nonsurgical, nonobstetric patients. Community-acquired cases initiated 25% of outbreaks; most were cases of necrotizing fasciitis in patients admitted to the intensive care unit. Outbreaks were small (median, 2 cases [range, 2 to 10 cases]) and short (median duration, 6 days [range, 0 to 30 days]). The median time between the first 2 cases was 4.5 days. The most common mode of propagation was patient-to-patient transmission. A staff carrier was the primary mode of transmission in 2 (10%) outbreaks, but 1 or more health care workers were colonized with the outbreak strain in 6 of 18 (33%) other outbreaks. Limitations: Some outbreaks with 1 case of invasive disease may have been missed; advice provided to participating hospitals may have reduced the number and size of outbreaks. Conclusions: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards.

AB - Background: Streptococcus pyogenes can cause severe disease in the individual patient and dramatic hospital outbreaks. Objective: To describe the epidemiology of hospital outbreaks of invasive group A streptococcal infection in order to understand the potential benefit of proposed outbreak investigation and management strategies. Design: Prospective, population-based surveillance. Setting: Short-term care hospitals in Ontario, Canada. Patients: Persons with a positive culture for group A streptococcus from a normally sterile site between 1 January 1992 and 31 December 2000. Measurements: Laboratory-based surveillance identified patients with nosocomial invasive group A streptococcal infection. Epidemiologic and microbiological investigations were used to detect transmission. Results: Of 2351 cases of invasive group A streptococcal disease, 291 (12%) were hospital acquired. Twenty-nine (10%) nosocomial cases occurred as part of 20 outbreaks. Seventy percent (14 of 20) of outbreaks involved nonsurgical, nonobstetric patients. Community-acquired cases initiated 25% of outbreaks; most were cases of necrotizing fasciitis in patients admitted to the intensive care unit. Outbreaks were small (median, 2 cases [range, 2 to 10 cases]) and short (median duration, 6 days [range, 0 to 30 days]). The median time between the first 2 cases was 4.5 days. The most common mode of propagation was patient-to-patient transmission. A staff carrier was the primary mode of transmission in 2 (10%) outbreaks, but 1 or more health care workers were colonized with the outbreak strain in 6 of 18 (33%) other outbreaks. Limitations: Some outbreaks with 1 case of invasive disease may have been missed; advice provided to participating hospitals may have reduced the number and size of outbreaks. Conclusions: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards.

UR - http://www.scopus.com/inward/record.url?scp=34548385636&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548385636&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-147-4-200708210-00004

DO - 10.7326/0003-4819-147-4-200708210-00004

M3 - Article

VL - 147

SP - 234

EP - 241

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 4

ER -