Cluster of deaths from group A streptococcus in a long-term care facility--Georgia, 2001.
BACKGROUND
Invasive group A streptococcus (GAS) affects approximately 10,500 persons annually; 1 in 5 patients >/=65 years die. In August 2001, CDC investigated a cluster of GAS deaths in a Georgia long-term care facility (LTCF).


METHODS
We screened LTCF residents and staff for GAS carriage and conducted a retrospective cohort study among residents. We defined a case as GAS isolation associated with clinical infection.


RESULTS
Eight cases were identified (median age: 79 years); 6 (75%) patients died. Carriage was similar in residents (10%) and staff (9%). All isolates among residents and 63% among staff were type emm 77. Risk factors for GAS disease or carriage among residents were receiving skin treatment (relative risk [RR] = 4.0, 95% confidence interval [CI] = 1.9-11.0) and having an infected or colonized roommate (RR = 2.0, 95% CI = 1.10-5.0). No wound care nurse carried GAS. Interventions included education about standardized infection control guidelines and appropriate hand hygiene; carriers were treated with antibiotics. No subsequent GAS cases were identified in the following year.


CONCLUSIONS
Transmission of GAS in this outbreak likely occurred during wound care and ended with improved hand hygiene. This investigation highlights additional research and policy needs for control of severe GAS infections among the high-risk LTCF population.
Greene
Carolyn M
CM
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cqg4@cdc.gov
Van Beneden
Chris A
CA
Javadi
Massoud
M
Skoff
Tami H
TH
Beall
Bernard
B
Facklam
Richard
R
Abercrombie
Debra R
DR
Kramer
Stacy L
SL
Arnold
Kate E
KE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009740:Nursing Staff; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013297:Streptococcus pyogenes / Q000302:isolation & purification*