title: [Molecular epidemiology of a streptococcus pyogenes related nosocomial outbreak in a burn unit].
abstract: BACKGROUND
  Group A Streptococcal (GAS) infections have increased in frequency and severity worldwide. During April 1996, a nosocomial outbreak associated to GAS infections affected seven patients admitted to a pediatric burn unit. The causative organism was likely disseminated from the source patient to another child in the emergency room before he was transferred to the burn unit. Patients developed burn infections or invasive disease. One of them died due to a toxic shock syndrome and 3 other lost their skin grafts. Perineal and nasal microbiological surveillance of 42 related health care workers identified only one of them as carrier of S pyogenes.
  
  
  OBJECTIVE
  To report a molecular analysis of an apparently clonal outbreak.
  
  
  METHODS
  The available isolates were analyzed by molecular methods including random amplified polymorphic DNA analysis (RAPD) with 4 different primers, Sma-I pulsed field gel electrophoresis (PFGE) analysis, and speA, speB and speC detection by polymerase chain reaction (PCR).
  
  
  RESULTS
  Two phylogenetically distant and sequentially isolated bacterial groups were identified either by RAPD analysis with selected primers or by Smal-PFGE analysis. The first group involved isolates identified in two patients that included the lethal case. The second bacterial group comprised 5 clinical isolates and the perineal and nasal isolates obtained from a health care worker. Only strains belonging to the first group harbored the speA gene and were associated with invasive disease. The second group could be split further in two subgroups according to their speB profile.
  
  
  CONCLUSIONS
  RAPD analysis with selected primers can reproduce the PFGE-discriminating ability on the epidemiological analysis of GAS infections.
authors.affiliation: Departamento de Medicina, Hospital Clínico Universidad de Chile, Av. Santos Dumont 999, Independencia, Santiago. afica@ns.hospital.uchile.cl
authors.forename: Alberto
authors.initials: A
authors.lastname: Fica
authors.forename: Jorge
authors.initials: J
authors.lastname: Fernández
authors.forename: Germán
authors.initials: G
authors.lastname: Ebensperger
authors.forename: Erna
authors.initials: E
authors.lastname: Cona
authors.forename: Andrea
authors.initials: A
authors.lastname: Galanti
authors.forename: Catalina
authors.initials: C
authors.lastname: Alonso
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Ulloa
authors.forename: Ana María
authors.initials: AM
authors.lastname: Frola
authors.forename: Soledad
authors.initials: S
authors.lastname: Prat
mesh_terms: D002053:Burn Units; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002677:Chile / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019105:Random Amplified Polymorphic DNA Technique; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D014774:Virulence
vernacular_title: Epidemiología molecular de un brote de infecciones por streptococcus pyogenes en una unidad de quemados.