Publications
| Nosocomial Invasive Group A Streptococcal Infections in Ontario |
Authors: N. Daneman, A. Mcgeer, D. Low, A. Plevneshi, K. Green
Background: A significant proportion of invasive group A Streptococcal infections are nosocomial in origin, and yet no large prospective studies have characterized this subgroup and evaluated the risk of transmission within the hospital setting
Method: We conducted prospective, population-based surveillance of all nosocomial and non-nosocomial invasive group A streptococcal infections across the province of Ontario, Canada from 1992 to 2000.
Results: We identified 291 (12.4%) nosocomial cases among a total of 2,351 cases of invasive group A streptococcal disease. The nosocomial infections were a heterogeneous group, including postsurgical (95 cases), postpartum (86 cases), and non-surgical, non-obstetrical infections (109 cases). Postsurgical infections affected 1/100,000 procedures, involving all organ systems, and with a variable time of onset (median 5 days). Postpartum infections occurred at a rate of 0.07/1000 live births, but exhibited an excellent prognosis. Non-surgical, non-obstetrical infections encompassed a broad range of infectious syndromes, and were subject to a high mortality rate. The overall mortality of nosocomial infections was 17.1%; risk factors for increased mortality included advanced age, underlying illness and delayed antibiotic use. Nosocomial outbreaks were prevalent (9.3% of cases), but usually involved only two linked cases, and always occurred over brief time spans (100% less than 1 month). A disproportionately high rate of transmission occurred from community-acquired cases of necrotizing fasciitis admitted to the intensive care unit, in comparison to other community acquired cases (2.2% v 0.05%, p<0.001).
Conclusions: Nosocomial invasive group A streptococcal infections are a diverse group including postsurgical, postpartum and non-surgical, non-obstetrical infections. The most effective prevention of nosocomial cross-transmission may require intervention after the first case.
Presented At:
45th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, 12/16/2005.
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1999 Microbiology Department, Mount Sinai Hospital, Toronto, ON, Canada.
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