Related Experiment Videos
The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes
H J Kolmos1, R N Svendsen, S V Nielsen
1Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Denmark.
Abstract:
Postoperative wound infection, caused by Streptococcus pyogenes transmitted during the operation from members of the surgical team, is a rare but serious complication of surgery. This study describes three cases, which could be traced to an orthopaedic surgeon, who carried the epidemic strain in this throat. Epidemiological characteristics of 14 other outbreaks, published in the English-language literature, are summarized. In total, these 15 outbreaks involved 136 patients. The overall case fatality rate was 12%. Anaesthesiologists and other assisting staff members were involved more often than surgeons and obstetricians. In outbreaks where an attack rate could be calculated, it was at least 7%. T-28 was the most commonly involved T-type, accounting for seven outbreaks. The anus and vagina were the most common carrier sites in staff members. A combination of penicillin and oral vancomycin seemed to be the most efficient treatment for anal and vaginal carriage. Relapse of carriage could occur several months after apparent eradication, and was often associated with a carrier in the family household.
Insights
Surgical site infections from Streptococcus pyogenes can be serious, often originating from asymptomatic carriers within the surgical team. Eradication of carriage requires persistent treatment, as relapses can occur, sometimes linked to household contacts.
Area of Science:
- Infectious Diseases
- Epidemiology
- Surgical Safety
Background:
- Postoperative wound infections pose a significant risk to surgical patients.
- Streptococcus pyogenes transmission during surgery is a rare but severe complication.
- Identifying the source of infection is crucial for preventing further outbreaks.
Observation:
- Three cases of postoperative wound infection were traced to an orthopaedic surgeon carrying an epidemic strain of Streptococcus pyogenes in their throat.
- A review of 14 additional outbreaks revealed 136 patients involved across 15 incidents.
- Anaesthesiologists and other staff were more frequently implicated than surgeons or obstetricians.
Findings:
- The overall case fatality rate for these Streptococcus pyogenes outbreaks was 12%.
- Attack rates in outbreaks were at least 7%, with T-28 being the most common T-type involved in seven outbreaks.
- The anus and vagina were identified as the most common carriage sites in healthcare staff.
Implications:
- Penicillin combined with oral vancomycin showed efficacy in treating anal and vaginal carriage of Streptococcus pyogenes.
- Relapse of carriage is possible months after apparent eradication, especially with household contacts.
- Enhanced surveillance and carrier screening protocols are essential for surgical teams to prevent nosocomial infections.