Journal Article

Hospital-Acquired Invasive Group A Streptococcal Infections in Ontario, Canada, 1992–2000

N. Daneman, A. McGeer, D. E. Low, G. Tyrrell, A. E. Simor, M. McArthur, B. Schwartz, P. Jessamine, R. Croxford and K. A. Green

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 3, pages 334-342
Published in print August 2005 | ISSN: 1058-4838
Published online August 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/431589
Hospital-Acquired Invasive Group A Streptococcal Infections in Ontario, Canada, 1992–2000

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Background. A significant proportion of invasive group A streptococcal infections are hospital acquired. No large, prospective studies have characterized this subgroup of cases and evaluated the risk of transmission in hospitals.

Methods. We conducted prospective, population-based surveillance of invasive group A streptococcal infections in Ontario, Canada, from 1992 to 2000. Epidemiologic and microbiologic investigations were conducted to identify cross-transmission.

Results. We identified 291 hospital-acquired cases (12.4%) among 2351 cases of invasive group A streptococcal disease. Hospital-acquired invasive group A streptococcal infections are heterogeneous, including surgical site (96 cases), postpartum (86 cases), and nonsurgical, nonobstetrical infections (109 cases). Surgical site infections affected 1 of 100,000 surgical procedures and involved all organ systems. Postpartum infections occurred at a rate of 0.7 cases per 10,000 live births and exhibited an excellent prognosis. Nonsurgical, nonobstetrical infections encompassed a broad range of infectious syndromes (case-fatality rate, 37%). Nine percent of cases were associated with in-hospital transmission. Transmission occurred from 3 of 142 patients with community-acquired cases of necrotizing fasciitis requiring intensive care unit (ICU) admission, compared with 1 of 367 patients with community-acquired cases without necrotizing fasciitis admitted to the ICU and 1 of 1551 patients with other cases (P < .001). Fifteen outbreaks were identified; 9 (60%) involved only 2 cases. Hospital staff were infected in 1 of 15 outbreaks, but colonized staff were identified in 6 (60%) of 10 investigations in which staff were screened.

Conclusions. Presentation of hospital-associated invasive group A streptococcal infections is diverse. Cross-transmission is common; illness occurs in patients but rarely in staff. Isolation of new cases of necrotizing fasciitis and intervention after a single nosocomial case may also prevent transmission.

Journal Article.  6900 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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