title: [A cluster of patients with puerperal fever in Gouda; a reiteration of the lesson by Semmelweis].
abstract: OBJECTIVE
  Description of a cluster of 6 patients who developed a puerperal infection with group A haemolytic streptococci (Streptococcus pyogenes, GAS) out of 10 patients who delivered during a 2-day period in the hospital in Gouda, the Netherlands, and of the epidemiological and microbiological search for the source.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  After the report on the fourth patient the suspicion of a hospital infection arose. Hospital staff, family members and environment were screened for GAS. All isolated GAS were serotyped and genotyped. Epidemiological data, like time of admission, delivery and discharge, used delivery room and maternity unit ward, were recorded. All regional midwives and general practitioners were informed and asked to be alert for puerperal endometritis in patients after hospital deliveries.
  
  
  RESULTS
  All 6 patients and 2 health care workers proved to have an identical type of GAS. The environmental cultures were negative. By analysing the epidemiological data the most probable cause of this cluster was found to be one health care worker. After stressing the importance of good hand disinfection no additional cases were seen.
authors.affiliation: Stichting Laboratorium van de Goudse Ziekenhuizen, afd. Microbiologie, Gouda.
authors.forename: E A
authors.initials: EA
authors.lastname: Thewessen
authors.forename: J
authors.initials: J
authors.lastname: Bontekoe-Hoornstra
authors.forename: A E
authors.initials: AE
authors.lastname: Smelting-Nagtzaam
authors.forename: M A
authors.initials: MA
authors.lastname: Bilkert-Mooiman
authors.forename: J F
authors.initials: JF
authors.lastname: Admiraal
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006282:Health Personnel; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology* / Q000382:microbiology; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*