Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T02:42:35.111Z Has data issue: false hasContentIssue false
  • English
  • Français

An Outbreak of Severe Group A Streptococcus Infections Associated with Podiatric Application of a Biologic Dermal Substitute

Published online by Cambridge University Press:  18 December 2015

Lauren A. Ibrahim ,
John A. Sellick Jr. ,
Elaine L. Watson ,
Lisa M. McCabe ,
Karen A. Schoenhals ,
Richard A. Martinello  and
Alan J. Lesse
Lauren A. Ibrahim
Affiliation:
Department of Medicine, University at Buffalo, Buffalo, New York
John A. Sellick Jr.*
Affiliation:
Department of Medicine, University at Buffalo, Buffalo, New York VA Western New York Healthcare System at Buffalo, Buffalo, New York
Elaine L. Watson
Affiliation:
VA Western New York Healthcare System at Buffalo, Buffalo, New York
Lisa M. McCabe
Affiliation:
VA Western New York Healthcare System at Buffalo, Buffalo, New York
Karen A. Schoenhals
Affiliation:
VA Western New York Healthcare System at Buffalo, Buffalo, New York
Richard A. Martinello
Affiliation:
Office of Public Health, Veterans Health Administration, Washington, DC Departments of Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
Alan J. Lesse
Affiliation:
Department of Medicine, University at Buffalo, Buffalo, New York VA Western New York Healthcare System at Buffalo, Buffalo, New York Departments of Pharmacology and Toxicology and Microbiology and Immunology, University at Buffalo, Buffalo, New York
*
Address correspondence to John A. Sellick, Jr., DO, Infectious Diseases (151), VA Western NY Healthcare System, 3495 Bailey Avenue, Buffalo, New York 14215 (jsellick@buffalo.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To describe an outbreak of severe Group A Streptococcus (GAS) infections that appeared to be associated with use of a biologic dermal substitute on foot wounds

DESIGN

Retrospective cohort study of cases and similar uninfected patients

SETTING/PATIENTS

Patients attending the podiatry clinic at a Veterans Affairs Medical Center between July 2011 and November 2011

INTERVENTIONS

Microbiology laboratory data were reviewed for the calendar year, a case definition was established and use of the biologic dermal substitute was discontinued. Staff were cultured to identify potentially colonized employees. A case–cohort study was designed to investigate risk factors for disease. Emm typing and pulsed field gel electrophoresis (PFGE) were performed to identify strain similarity.

RESULTS

In 10 months, 14 cases were identified, and 4 of these patients died. All strains were emm type 28 and were identical according to PFGE. Discontinuation of biologic dermal substitute use halted the outbreak. A prior stroke was more common in the case cohort vs uninfected patient cohorts. The number of patients attending the clinic on 13 probable transmission days was significantly higher than on nontransmission days. We identified 2 patients who were present in the clinic on all but 1 probable transmission day. Surveillance cultures of podiatry clinic staff and cultures of the same lot of retained graft material were negative.

CONCLUSIONS

A carrier was not identified, and we believe the outbreak was associated with inter-patient transmission likely due to lapses in infection control techniques. No additional cases have been identified in >3 years following the resumption of dermal substitute use in May 2012.

Infect. Control Hosp. Epidemiol. 2016;37(3):306–312

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 306 - 312
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PRESENT AFFILIATIONS. At the time of the case–cohort study, Dr. Ibrahim was a fellow in the Division of Infectious Diseases at the University at Buffalo, Buffalo, New York; she now is in private practice in Hartford, Connecticut. Ms. Watson is now with the Genessee County (New York) Health Department, and Ms. McCabe is with Catholic Health System in Buffalo. Dr. Martinello is no longer affiliated with the Veterans Health Administration.

PREVIOUS PRESENTATION. The epidemiologic investigation described in this paper was presented at ID Week 2012, October 17–21, 2012, San Diego, California (Abstract no. 255).

References

REFERENCES

1. Cockerill, FR 3rd, MacDonald, KL, Thompson, RL, et al. An outbreak of invasive group A streptococcal disease associated with high carriage rates of the invasive clone among school-aged children. JAMA 1997;277:38–43.CrossRefGoogle Scholar
2. Molecular Typing PGFE Protocols. Pulse Net International website. http://www.pulsenetinternational.org/protocols/Pages/default.aspx#protocols. Updated October 2015. Accessed November 19, 2015.Google Scholar
3. Ogden, E, Amstey, MS, Puerperal infection due to group A beta hemolytic streptococcus. Obstet Gynecol 1978;52:53–55.Google Scholar
4. Bisno, AL, Stevens, DL. Streptococcus pyogenes. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease, 7th ed. Philadelphia, PA: Elsevier: 2010:2593–2610.Google Scholar
5. Active Bacterial Core surveillance report, Emerging Infections Program Network, group A Streptococcus, 1997–2010. Centers for Disease Control and Prevention website. http://www.cdc.gov/abcs/reports-findings/survreports/gas10.pdf. Published 2012. Accessed January 28, 2013.Google Scholar
6. DiPersio, JR, File, TM Jr., Stevens, DL, Gardner, WG, Petropoulos, G, Dinsa, K. Spread of serious disease-producing M3 clones of group A streptococcus among family members and health care workers. Clin Infect Dis 1996;22:490–495.Google Scholar
7. Auerbach, SB, Schwartz, B, Williams, D, et al. Outbreak of invasive group A streptococcal infections in a nursing home. Lessons on prevention and control. Arch Intern Med 1992;152:1017–1022.Google Scholar
8. Deutscher, M, Schillie, S, Gould, C, et al. Investigation of a group A streptococcal outbreak among residents of a long-term acute care hospital. Clin Infect Dis 2011;52:988–994.Google Scholar
9. Milne, LM, Lamagni, T, Efstratiou, A, et al. Streptococcus pyogenes cluster in a care home in England April to June 2010. Euro Surveill 2011;16:20021.Google Scholar
10. Invasive group A streptococcus in a skilled nursing facility—Pennsylvania, 2009–2010. MMWR Morb Mortal Wkly Rep 2011;60:1445–1449.Google Scholar
11. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950–959.Google Scholar
12. O'Brien, KL, Beall, B, Barrett, NL, et al . Epidemiology of invasive group A streptococcus disease in the United States, 1995–1999. Clin Infect Dis 2002;35:268–276.Google Scholar
13. Chuang, I, Van Beneden, C, Beall, B, Schuchat, A. Population-based surveillance for postpartum invasive group a streptococcus infections, 1995-2000. Clin Infect Dis 2002;35:665–670.Google Scholar
14. Ben Zakour, NL, Venturini, C, Beatson, SA, Walker, MJ. Analysis of a Streptococcus pyogenes puerperal sepsis cluster by use of whole-genome sequencing. J Clin Microbiol 2012;50:2224–2228.Google Scholar
15. Mihaila-Amrouche, L, Bouvet, A, Loubinoux, J. Clonal spread of emm type 28 isolates of Streptococcus pyogenes that are multiresistant to antibiotics. J Clin Microbiol 2004;42:3844–3846.Google Scholar
16. Green, NM, Beres, SB, Graviss, EA, et al. Genetic diversity among type emm28 group A Streptococcus strains causing invasive infections and pharyngitis. J Clin Microbiol 2005;43:4083–4091.Google Scholar
17. Marston, WA. Dermagraft, a bioengineered human dermal equivalent for the treatment of chronic nonhealing diabetic foot ulcer. Expert Rev Med Devices 2004;1:21–31.Google Scholar
18. Wang, B, Li, S, Southern, PJ, Cleary, PP. Streptococcal modulation of cellular invasion via TGF-beta1 signaling. Proc Natl Acad Sci USA 2006;103:2380–2385.Google Scholar
19. Smith, A, Li, A, Tolomeo, O, Tyrrell, GJ, Jamieson, F, Fisman, D . Mass antibiotic treatment for group A streptococcus outbreaks in two long-term care facilities. Emerg Infect Dis 2003;9:1260–1265.Google Scholar
20. Greene, CM, Van Beneden, CA, Javadi, M, et al . Cluster of deaths from group A streptococcus in a long-term care facility—Georgia, 2001. Am J Infect Control 2005;33:108–113.CrossRefGoogle Scholar
21. Arnold, KE, Schweitzer, JL, Wallace, B, et al . Tightly clustered outbreak of group A streptococcal disease at a long-term care facility. Infect Control Hosp Epidemiol 2006;27:1377–1384.Google Scholar
22. Thigpen, MC, Richards, CL Jr., Lynfield, R, et al . Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998–2003. Emerg Infect Dis 2007;13:1852–1859.Google Scholar
23. Prevention of Invasive Group ASIWP. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950–959.CrossRefGoogle Scholar
24. Centers for Disease C. Nursing home outbreaks of invasive group A streptococcal infections—Illinois, Kansas, North Carolina, and Texas. MMWR Morb Mortal Wkly Rep 1990;39:577–579.Google Scholar
25. Schwartz, B, Ussery, XT. Group A streptococcal outbreaks in nursing homes. Infect Control Hosp Epidemiol 1992;13:742–747.Google Scholar
26. Rainbow, J, Jewell, B, Danila, RN, et al. Invasive group a streptococcal disease in nursing homes, Minnesota, 1995–2006. Emerg Infect Dis 2008;14:772–777.Google Scholar
27. Ridgway, EJ, Allen, KD . Clustering of group A streptococcal infections on a burns unit: important lessons in outbreak management. J Hosp Infect 1993;25:173–182.Google Scholar
28. Daneman, N, McGeer, A, Low, DE, et al . Hospital-acquired invasive group A streptococcal infections in Ontario, Canada, 1992–2000. Clin Infect Dis 2005;41:334–342.Google Scholar
29. Nolan, L, Schertzberg, R, Wilson-Clark, S, McGeer, A, Pellizzari, R, Steingart, C . Outbreak of invasive group A streptococcal disease in two hospitals, Ontario, 2003. Can Commun Dis Rep 2008;34:8–19.Google Scholar
30. Thomas, JC, Carr, SJ, Fujioka, K, Waterman, SH . Community-acquired group A streptococcal deaths in Los Angeles County. J Infect Dis 1989;160:1086–1087.Google Scholar
31. Wheeler, MC, Roe, MH, Kaplan, EL, Schlievert, PM, Todd, JK . Outbreak of group A streptococcus septicemia in children. Clinical, epidemiologic, and microbiological correlates. JAMA 1991;266:533–537.Google Scholar
32. Stromberg, A, Romanus, V, Burman, LG . Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study. J Infect Dis 1991;164:595–598.Google Scholar
33. Benjamin, EM, Gershman, M, Goldberg, BW . Community-acquired invasive group A beta-hemolytic streptococcal infections in Zuni Indians. Arch Intern Med 1992;152:1881–1884.Google Scholar
34. Kiska, DL, Thiede, B, Caracciolo, J, et al . Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis 1997;176:992–1000.Google Scholar
35. Siljander, T, Lyytikainen, O, Vahakuopus, S, Saila, P, Jalava, J, Vuopio-Varkila, J. Rapid emergence of emm84 among invasive Streptococcus pyogenes infections in Finland. J Clin Microbiol 2009;47:477–480.Google Scholar
36. Martin, J, Murchan, S, O'Flanagan, D, Fitzpatrick, F . Invasive Group A streptococcal disease in Ireland, 2004 to 2010. Euro Surveill 2011;16.Google Scholar
37. Dooling, KL, Crist, MB, Nguyen, DB, et al . Investigation of a prolonged Group A Streptococcal outbreak among residents of a skilled nursing facility, Georgia, 2009–2012. Clin Infect Dis 2013;57:1562–1567.Google Scholar
38. Beaudoin, AL, Torso, L, Richards, K, et al . Invasive group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regulation. JAMA Internal Medicine 2014;174:1136–1142.CrossRefGoogle ScholarPubMed
39. Lee, EH, Ferguson, D, Jernigan, D, et al. Invasive group-A streptococcal infection in an allograft recipient. A case report. J Bone Joint Surg Am 2007;89:2044–2047.Google Scholar
40. Felkner, M, Pascoe, N, Shupe-Ricksecker, K, Goodman, E. The wound care team: a new source of group a streptococcal nosocomial transmission. Infect Control Hosp Epidemiol 2005;26:462–465.Google Scholar
41. Salipante, SJ, SenGupta, DJ, Cummings, LA, Land, TA, Hoogestraat, DR, Cookson, BT. Application of whole-genome sequencing for bacterial strain typing in molecular epidemiology. J Clin Microbiol 2015;53:1072–1079.Google Scholar