title: Cluster of deaths from group A streptococcus in a long-term care facility--Georgia, 2001.
abstract: 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.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cqg4@cdc.gov
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Greene
authors.forename: Chris A
authors.initials: CA
authors.lastname: Van Beneden
authors.forename: Massoud
authors.initials: M
authors.lastname: Javadi
authors.forename: Tami H
authors.initials: TH
authors.lastname: Skoff
authors.forename: Bernard
authors.initials: B
authors.lastname: Beall
authors.forename: Richard
authors.initials: R
authors.lastname: Facklam
authors.forename: Debra R
authors.initials: DR
authors.lastname: Abercrombie
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Kramer
authors.forename: Kate E
authors.initials: KE
authors.lastname: Arnold
mesh_terms: 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*