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A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus
Insights
Group A streptococci caused an outbreak in a newborn nursery, leading to omphalitis and other infections. A combination of triple dye and penicillin prophylaxis successfully eradicated the epidemic strain.
Area of Science:
- Neonatal infections
- Bacterial pathogenesis
- Infectious disease epidemiology
Background:
- Group A streptococci (GAS) can cause serious infections in newborns.
- An outbreak of GAS colonization and infection occurred in a neonatal nursery.
Purpose of the Study:
- To describe the clinical manifestations and epidemiology of a GAS outbreak in a neonatal nursery.
- To evaluate the effectiveness of different control measures against GAS colonization and infection.
Main Methods:
- Retrospective review of infant medical records during a six-month period.
- Identification and characterization of the epidemic GAS strain.
- Assessment of the impact of benzathine penicillin prophylaxis and triple dye treatment on GAS eradication.
Main Results:
- Sixty-nine infants were colonized with GAS, with 51 cases of omphalitis.
- Active infections were suppressed by penicillin prophylaxis, but asymptomatic colonization persisted.
- Combined triple dye treatment and penicillin prophylaxis eradicated GAS from the nursery.
Conclusions:
- A novel skin strain of GAS (provisional type strain 5656-S) caused a difficult-to-control nursery epidemic.
- Effective nursery-wide eradication required a multifaceted approach combining topical treatment and antibiotic prophylaxis.
Abstract:
During a six-month period 69 infants in a newborn nursery were colonized with group A streptococci. Fifty-one had omphalitis, two infected circumcision wounds, and one each had meningitis, primary peritonitis, and conjunctivitis. Thirteen infants were asymptomatically colonized. Control of the epidemic was difficult. Benzathine penicillin prophylaxis to all infants suppressed active infection but did not eradicate asymptomatic colonization of the umbilical cord. Triple dye treatment of the umbilical cord plus benzathine penicillin prophylaxis eradicated the infection from the nursery. The epidemic streptococcus was a newly recognized ""skin strain,'' provisional type strain 5656-S, not previously known to cause epidemic disease or serious systemic infections.