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Streptococcus pyogenes outbreak in a long-term care facility.

G A Harkness1, D W Bentley, M Mottley

  • 1University of Rochester School of Medicine, University of Rochester Medical Center, NY.

American Journal of Infection Control
|June 1, 1992
PubMed
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Streptococcus pyogenes outbreaks in long-term care facilities are a serious concern. This study highlights the importance of early detection, prompt treatment, and surveillance to control the spread of this pathogen in elderly populations.

Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Geriatrics

Background:

  • Streptococcus pyogenes outbreaks are uncommon in the elderly but pose significant risks in long-term care facilities.
  • Recent reports indicate S. pyogenes as a notable nosocomial pathogen in institutionalized older adults, associated with high morbidity and mortality.
  • A specific outbreak of S. pyogenes (type M12, T12) affected 14 residents over 4 months in a long-term care institution.

Purpose of the Study:

  • To investigate an outbreak of Streptococcus pyogenes in a long-term care facility.
  • To identify transmission routes, clinical manifestations, and risk factors associated with the outbreak.
  • To inform control and prevention strategies for S. pyogenes infections in institutionalized elderly populations.

Main Methods:

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  • A prospective epidemiological investigation was conducted during the outbreak.
  • Data collection included interviews, medical record reviews, and patient examinations.
  • Cultures, serological tests (Streptozyme), and surveillance of residents and staff were employed.

    • Main Results:

    • The attack rate was 7.5%, with most cases concentrated on one unit.
    • S. pyogenes was isolated from eight residents; five presented with characteristic syndromes and elevated antibody titers.
    • Clinical presentations ranged from cellulitis to septicemia, with a case fatality rate of 14.3% (2 deaths).

    Conclusions:

    • Direct resident-to-resident contact was the primary transmission route, with possible staff-to-resident transmission.
    • Long-term colonization may contribute to the extended duration of infections.
    • Effective control requires early lesion detection, recognition of invasive disease, prompt treatment, and ongoing surveillance.