Non-invasive Infections Research Articles

Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis

ObjectivesThe epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae) outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages. MethodsA systematic review (PROSPERO CRD42017068914) and meta-analysis of GBS as a proportion (%) of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI) was conducted. ResultsSeventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI) 0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%) of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%) of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%) were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%) and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%) of community and 0.27% (95% CI 0.15–0.48%) of hospital RTI isolates. ConclusionsGBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.

Paediatric Salmonellosis-Differences between Tropical and Sub-Tropical Regions of Queensland, Australia.

Salmonellosis is an important cause of morbidity in tropical regions.This study aims to describe the epidemiology of non-typhoidal Salmonellae (NTS) in children presenting to public hospitals in Queensland, Australia, over the past 20 years, with a focus on differences between tropical and sub-tropical zones in the region. This is a retrospective and descriptive cohort study of 8162 NTS positive samples collected in 0–17-year-olds from the Queensland public hospital pathology database (Auslab) over a 20-year period from 1997 to 2016. There were 2951 (36.2%) positive NTS samples collected in tropical zones and 5211 (63.8%) in the sub-tropical zones of Queensland, with a total of 8162 over the region. The tropical zone contributed a disproportionately higher number of positive NTS samples by population sub-analysis. Of the specimens collected, 7421 (90.92%) were faecal, 505 (6.2%) blood, 161 (1.97%) urine, 13 (0.16%) cerebrospinal fluid (CSF) and 62 of other origin. Other categories of specimen types isolated include swab, fluid, aspirate, lavage, bone, tissue, isolate and pus, and these were not included in sub-analysis. The most commonly identified serovars were Salmonella Typhimurium, Salmonella Virchow and Salmonella Saintpaul. This is the first and largest study that emphasises the high burden of invasive and non-invasive NTS infections resulting in hospital presentations in the paediatric population of tropical north Queensland, compared to the sub-tropics.

Epidemiology of invasive and non-invasive pneumococcal infections in hospitalised adult patients in a Lebanese medical centre, 2006–2015

This is a retrospective medical file review of adult inpatients with Streptococcus pneumoniae infections admitted to a Lebanese hospital between 2006 and 2015. We revisited the clinical scenarios of these infections in view of increasing antibiotic resistance in Lebanon. One hundred and three patients were included; 92% were eligible for pneumococcal vaccination, yet none were vaccinated. Non-invasive pneumococcal disease (non-IPD) represented 64% of these infections. Superinfections caused by antibiotic-resistant bacteria were documented in 17.5% of the patients, with the predominance of ventilator-associated pneumonia (12.6%). Kidney disease and septic shock were positive predictors for mortality [adjusted odds ratio (OR) = 14.96, 95% confidence interval (CI) 2.34–95.45, P = 0.004; OR = 5.09, 95% CI 1.33–19.51, P = 0.02, respectively]. Herein, the differences in clinical success, S. pneumoniae infection-related death, and total mortality were not statistically significant between invasive pneumococcal disease (IPD) and non-IPD subgroups (59.5% vs. 77.3%, P = 0.056; 21.6% vs. 9.1%, P = 0.08; and 35.1% vs. 22.7%, P = 0.174; respectively). Upon comparing antibiotic susceptibility of S. pneumoniae during the first two years of the study (2006–2007) (n = 32 isolates) and the last two (2014–2015) (n = 14 isolates), there was an increasing non-susceptibility to penicillin (34.4%–50.0%, P = 0.25), and a decreasing susceptibility to erythromycin and clindamycin (81.3%–78.6%, P = 0.67 and 90.6%–85.7%, P = 0.65; respectively).

Scarlet fever: Clinical overview of a rising public health concern

Scarlet fever (scarlatina) is a common childhood infection which is caused by the Streptococcus pyogenes (group A Streptococcus [GAS]) bacterium ( Public Health England [PHE], 2017 ). The incidence of this disease has been increasing since 2008 in Asia and the UK ( Guy et al, 2014 ; Lau et al, 2012 ). Generally, these bacteria cause few problems, but GAS can cause non-invasive infections such as pharyngitis, impetigo and scarlet fever ( Duncan, 2007 : PHE, 2017 ; Walker et al, 2014 ). The more serious sequelae and rarer complications are streptococcal toxic shock syndrome, rheumatic heart disease and streptococcal glomerulonephritis, necrotising fasciitis, and septicaemia ( Duncan, 2007 ; Lamden, 2011 ). This article provides a clinical overview of scarlet fever. This includes the presentation of the disease, treatment, the possible complications and any preventive measures.

Laboratory Based Surveillance of Pneumococcal Serotypes causing Invasive and Non-Invasive Infections in Karachi, Pakistan

Laboratory Based Surveillance of Pneumococcal Serotypes causing Invasive and Non-Invasive Infections in Karachi, Pakistan

Direct detection, capsular typing and β-lactamase resistance genes in Haemophilus influenzae isolated from sinusitis samples

Objective: Haemophilus influenzae is the causative agent of invasive and noninvasive infections such as chronic obstructive lung disease exacerbation, sinusitis, otitis media, and conjunctivitis. The study was undertaken to direct detection, capsular typing, and investigate the occurrence of β-lactamase resistance genes in H. influenzae strains isolated from sinusitis samples. Materials and methods: We investigated the presence of H influenzae in 137 sinusitis samples obtained from the patients had referred to Rasoole-Akram Hospital in Tehran in 2017. DNA extraction was performed according to the QIAamp kit. polymerase chain reaction (PCR) amplification was performed with specific primers to determine H. influenzae and capsular-typing and to detect resistance genes. Results: Eleven samples were positive for the presence of H. influenzae. Overall, 5, 2, and 4 isolates were H. influenzae type b, type A, and nontypeable H. influenzae, respectively. Of 11 isolates of H. influenzae, only two isolates (18%) were β-lactamase positive and carried the TEM-1 gene, but others were negative for the ROB-1 gene. As well, the current study showed that 45.5% (n; five of 11 encapsulated H. influenzae) of isolates were type b, which were the predominant types. Conclusion: Our data suggest that the conventional PCR can help increase detection rates of bacterial cause of sinusitis and resistance genes in clinical samples for effective treatment in individual sensitive to invasive infection.

The Pneumococcus and Its Critical Role in Public Health.

Streptococcus pneumoniae is one of the commonest bacteria that cause morbidity and mortality in children and the elderly. The two extremes of age and individuals with underlying disease are particularly at risk of developing pneumococcaldisease. The pneumococcus is responsible for a wide range of infectious diseases, ranging from mild, non-invasive infections such as otitis media and sinusitis, to more severe infections including pneumonia, septicemia, and meningitis. Despite the licensure of highly effective pneumococcal conjugate vaccines, the control of pneumococcal disease is still challenging. Here we describe the critical role of Streptococcus pneumoniae in public health.

Ixekizumab for the treatment of psoriasis: an update on new data since first approval

ABSTRACTIntroduction: Psoriasis is a chronic immune-mediated skin disease with a multifactorial etiology. Studies have shown that the inflammatory cytokine interleukin-17A (IL-17A) is a key mediator in the pathogenesis. Targeted biologics have changed the outcome for patients in a variety of diseases including psoriasis. Ixekizumab is a humanized monoclonal antibody directed against IL-17A and it has been approved for the treatment of moderate-to-severe plaque psoriasis, and recently also psoriatic arthritis.Areas covered: In this review, we summarize the latest clinical study results on ixekizumab. Long-term Phase III study data on efficacy and safety are now available for both plaque psoriasis and psoriatic arthritis. Additionally, new indications for ixekizumab are under investigation.Expert commentary: Overall, the efficacy and safety of ixekizumab are promising. In plaque psoriasis, the efficacy of ixekizumab was superior to etanercept and ustekinumab, while the efficacy was comparable to adalimumab in psoriatic arthritis. The safety profile has also been found very tolerable and similar to other biologics; however, vigilance regarding non-invasive Candida infections is necessary. Also, caution is advised when treating patients with concomitant inflammatory bowel disease, since ixekizumab could cause exacerbations. Long-term studies in real-life treatment settings are needed to decide the actual potential and safety of ixekizumab.

Changes in the serotype distribution of Streptococcus pneumoniae causing otitis media after PCV13 introduction in Spain.

One of the beneficial effects of pneumococcal conjugate vaccines (PCVs) has been a decrease in the incidence of non-invasive infections, such as otitis media (OM) caused by vaccine serotypes. In this study, we analyzed the epidemiology of pneumococcal OM before and after PCV13 introduction in 2010. Between 2008 and 2016, the middle ear exudates from 2653 children under 14 years of age with OM were studied in two Spanish provinces (Gipuzkoa and Barcelona), and S. pneumoniae was isolated in 235 (8.9%) of cases. The 204 available isolates were serotyped and distributed in three 3-year periods: one before and two after PCV13 introduction (early and late post-PCV13). A significant decrease in the rate of OM caused by S. pneumoniae was observed mainly due to a decrease in infections caused by all PCV13 serotypes, although exceptions were observed including the persistence of serotype 3 in Gipuzkoa and a weak re-emergence of serotype 19F in both regions. The rate and diversity of non-PCV13 serotypes increased in both regions and an emerging clone causing OM was detected in each region: serotype 23B ST2372 in Gipuzkoa and serotype 11A ST838/ST6521 in Barcelona. The introduction of PCV13 has been followed by a change in the epidemiology of pneumococcal OM, with a decrease in the rate of vaccine serotypes accompanied by an increase in the diversity of non-vaccine serotype and the clonal spreading of different single clones in each region.

Generation of A Mucor circinelloides Reporter Strain-A Promising New Tool to Study Antifungal Drug Efficacy and Mucormycosis.

Invasive fungal infections caused by Mucorales (mucormycosis) have increased worldwide. These life-threatening infections affect mainly, but not exclusively, immunocompromised patients, and are characterized by rapid progression, severe tissue damage and an unacceptably high rate of mortality. Still, little is known about this disease and its successful therapy. New tools to understand mucormycosis and a screening method for novel antimycotics are required. Bioluminescent imaging is a powerful tool for in vitro and in vivo approaches. Hence, the objective of this work was to generate and functionally analyze bioluminescent reporter strains of Mucor circinelloides, one mucormycosis-causing pathogen. Reporter strains were constructed by targeted integration of the firefly luciferase gene under control of the M. circinelloides promoter Pzrt1. The luciferase gene was sufficiently expressed, and light emission was detected under several conditions. Phenotypic characteristics, virulence potential and antifungal susceptibility were indifferent to the wild-type strains. Light intensity was dependent on growth conditions and biomass, being suitable to determine antifungal efficacy in vitro. This work describes for the first time the generation of reporter strains in a basal fungus that will allow real-time, non-invasive infection monitoring in insect and murine models, and the testing of antifungal efficacy by means other than survival.

2285. Burden of Invasive and Non-Invasive Group B Streptococcal Infections in Hospitalized Adults, Louisville, Kentucky: A Large Population-Based Study

BackgroundAlthough Group B Streptococcus (GBS) has been recognized as an important cause of infections in adults, most studies have concentrated on patients with invasive disease. CDC estimates that there are >25,000 adult invasive cases in the United States/year. The objective of this study was to determine the burden of invasive and noninvasive GBS infections in hospitalized patients in Louisville, KY with the goal of determining the total burden of GBS infections in the United States.MethodsWe conducted a population-based, observational study of all hospitalized adults with GBS isolated from cultures and clinical evidence of active infection from 2014 to 2016 in a well-defined catchment area. Data regarding demographics, medical history, infection sites and microbiology were extracted from medical records. If GBS was isolated from more than one clinical site, the most invasive or deepest site was considered the primary infected site.ResultsOf 1428 GBS isolations 352 were considered colonizations therefore 1076 infections were included; Fifty-one percent were males and the median age was 52 years. Twenty-four percent were black and 2% Hispanic. Sixty-six (6%) presented from a nursing home. The median length of hospital stay was 5.2 days and 31 (3%) died. Patients had the following comorbidities: 627 (59%) diabetes, 220 (21%) renal disease, 221 (21%) coronary artery disease, and 154 (14%) peripheral vascular disease. In 642 patients (60%) GBS was the only organism isolated (monomicrobial) and in 320 (30%) GBS was isolated from more than one clinical site. Two hundred and twelve (20%) of patients had isolates from normally sterile sites (invasive). The primary site of infection included 425 (39%) skin and soft tissue, 252 (23%) urinary, 173 (16%) bone or joint, 115 (11%) from blood, 57 (5%) respiratory, 26 (2.4%) cardiovascular, and 25 (2.3%) abdominal.ConclusionTo our knowledge, this is the first study to determine the total burden of both invasive and noninvasive GBS disease among adult hospitalized patients in the United States. Our results suggest that only 20% of cases are invasive indicating that the burden of GBS is up to five times higher than estimates based on invasive infections.Disclosures P. Peyrani, Pfizer Inc.: Employee, Salary. A. Quinn, Pfizer Inc.: Employee, Salary. D. L. Swerdlow, Pfizer Inc.: Employee and Shareholder, Salary.

Individual protection and population effect – two sides of one medal

The studies of the serotype composition of pneumococci in various countries indicate that over 80% of the most severe invasive diseases are caused by 20 serotypes, and 13 serotypes cause 70–75% of diseases globally [3]. The vaccination of the population is the main way to reduce the incidence of both invasive and non-invasive pneumococcal infections. With evidence of the safety and efficacy of pneumococcal conjugate vaccines, WHO and UNCF consider it necessary to include these vaccines for children in the national immunization programs around the world.

The Role of Streptococcus Agalactiae in Surgical Site and Non-Invasive Bacterial Infections: A Systematic Review and Meta-Analysis

Background: Group B streptococcal (GBS; Streptococcus agalactiae) disease epidemiology outside of pregnancy and the neonatal period is poorly characterised. We aimed to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages. Methods: Systematic review of publications between 01/01/2000-05/07/2017 without language restriction. Meta-analysis of S. agalactiae as a proportion (%) of the total number of bacterial isolates in surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI). PROSPERO reg. CRD42017068914. Findings: 74 studies and data sources were included. Overall prevalence of S. agalactiae in SSI isolates was 0.25% for abdominal and 0.22% for cardiac surgery. In orthopaedic surgery, S. agalactiae accounted for 0.37% (95% CI 0.08-1.68%), 0.87% (0.33-2.28%) and 1.46% (0.49-4.29%) of superficial, deep and organ/space SSI, respectively. S. agalactiae played a more significant role as a cause of post caesarean section SSI, detected in 2.92% (1.51-5.55%), 1.93% (0.97-3.81%) and 9.69% (6.72-13.8%) of superficial, deep and organ/space SSI. 1.89% (1.16-3.05%) of SSTI isolates were identified as S. agalactiae. Prevalence of S. agalactiae in community and hospital UTI isolates was 1.61% (1.13-2.30%) and 0.73% (0.43-1.23%). S. agalactiae was uncommonly associated with RTI, accounting for 0.35% (0.19-0.63%) of community and 0.27% (0.15-0.48%) of hospital RTI isolates. Interpretation: Worldwide, GBS is implicated in a small proportion (1-2%) of SSI, SSTI and UTI, a very small proportion (<0.5%) of RTI, and a substantial proportion (10%) of invasive SSI following caesarean section. Funding: This study was funded by Pfizer Inc. Declaration of Interest: The authors declare no competing interests. Ethical Approval: The protocol for this systematic review and meta-analysis was defined in advance and registered with PROSPERO (reg. no. CRD42017068914).

Adherence to pneumococcal conjugate vaccination schedule and uptake rate as compared to the established diphtheria-tetanus-acellular pertussis vaccination in Cyprus

BackgroundPneumococcus is a common cause of invasive and non-invasive infections in children. In areas with high vaccination coverage, universal infant vaccination with conjugated pneumococcal vaccine (PCV) has significantly decreased the incidence of vaccine type nasopharyngeal carriage and invasive pneumococcal disease. The aim of this study is to examine immunization coverage rate and timely administration of the recently introduced PCV and compare to the established diphtheria-tetanus-acellular pertussis vaccine (DTaP) with similar schedule. MethodsA stratified random sample of healthy infants and children 6–36 months of age were recruited. Demographic data were collected from parents. Among enrolled children, immunization status for DTaP and PCV was noted from the child's health booklet. ResultsOf 1105 children enrolled in the study, 586 (53%) were vaccinated in the private sector and the rest in the public sector. A significant higher proportion of children vaccinated at the private sector were fully vaccinated for PCV (71% versus 58%, p < 0.05) while no difference in the DTaP coverage was observed. Conversely, the compliance to the recommended vaccination schedule was much higher in the public sector for the first and second dose of PCV and second dose of DTaP.The overall, timely administration was higher for the DTaP vaccine when compared to PCV (p < 0.05).Moreover, adherence to the program was higher for the firstborn child of the family while significant differences were observed between different geographic regions. Interestingly, co-administration of DTaP and PCV was observed in only 2% of the children. ConclusionIn children residing in Cyprus, vaccination coverage and adherence to PCV vaccination schedule are significantly lower compared to the established DTaP vaccine. There is an urgent need for increasing the overall vaccination coverage as well as improving the adherence to vaccination schedule. Possible interventions are proposed.

Group A Streptococcus.

1. Monika L. Dietrich, MD* 2. Russell W. Steele, MD†,‡ 1. *Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 2. †Department of Pediatrics, Ochsner Health Center for Children, New Orleans, LA 3. ‡University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA * Abbreviations: ANF: : acute necrotizing fasciitis ARF: : acute rheumatic fever GAS: : group A Streptococcus IVIG: : intravenous immunoglobulin MRSA: : methicillin-resistant Staphylococcus aureus MSSA: : methicillin-susceptible S aureus PANDAS: : pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections PSGN: : poststreptococcal glomerulonephritis STSS: : streptococcal toxic shock syndrome 1. Clinical prediction rules for group A Streptococcus pharyngitis are unreliable in children, and unless viral etiology is strongly suspected, throat swab with a rapid antigen detection test should be performed. 2. Avoid “proof of cure” cultures when treating pharyngitis. 3. Clindamycin is important in invasive group A Streptococcus infection for toxin mediation but should not be used alone secondary to possible resistance. After completing this article, readers should be able to: 1. Understand the epidemiology, transmission, and major virulence factors of group A Streptococcus (GAS) infections. 2. Plan the appropriate diagnostic evaluation of suspected GAS infection. 3. Recognize the clinical features of, and major complications associated with, invasive and noninvasive GAS infections. 4. Plan appropriate management for a patient with a GAS infection. In 1933, Rebecca Lancefield changed our understanding of β-hemolytic streptococci by developing a system of serologic classification based on the carbohydrate composition of cell wall antigens. Of these organisms, the most significant in human pathogenicity is group A Streptococcus (GAS), otherwise known as Streptococcus pyogenes . (1) GAS is responsible for an impressively wide variety of clinical manifestations, from noninvasive infections, such as pharyngitis, scarlet fever, erysipelas, and cellulitis, to invasive disease, including sepsis, streptococcal toxic shock syndrome (STSS), and necrotizing fasciitis (Table 1). It has also been linked to multiple nonsuppurative complications including acute rheumatic fever (ARF), poststreptococcal glomerulonephritis (PSGN), and the controversial pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Globally, an estimated 18 million people are suffering from a serious GAS-related illness, with about 1.78 million new cases annually. Hundreds of millions of people develop less serious GAS infection every year, placing a massive burden on healthcare systems. The …

Introduction to the SAVE study (2011-15): Streptococcus pneumoniae serotyping and antimicrobial susceptibility: Assessment for Vaccine Efficacy in Canada after the introduction of PCV-13.

Streptococcus pneumoniae continues to be an important bacterial pathogen associated with invasive (e.g. bacteraemia) and non-invasive (e.g. community-acquired respiratory tract) infections worldwide. Surveillance studies conducted nationally and globally can assist in determining trends across geographical areas and allow comparisons between countries. SAVE is an ongoing, annual, national study focused on characterizing invasive isolates of S. pneumoniae obtained across Canada. This Supplement documents the initial 5 years of the SAVE study (2011-15) during which 6207 invasive isolates of S. pneumoniae were evaluated. The three manuscripts in this Supplement provide a comprehensive examination of the changing patterns of invasive S. pneumoniae obtained across Canada over a 5 year period. The data highlight the evolution of S. pneumoniae antimicrobial resistance and multidrug resistance, serotype distribution, genotypic relatedness and virulence under pressure by vaccination and antimicrobial usage. This allows both clinicians and researchers nationally and globally to view the current status of invasive pneumococcal infections in Canada.

Epidemiology of an upsurge of invasive group A streptococcal infections in Ireland, 2012–2015

Group A streptococcus (GAS) is responsible for mild to very severe disease. The epidemiology of an upsurge in invasive GAS (iGAS) infections in Ireland, 2012-2015 was investigated. Epidemiological typing of iGAS (n = 473) isolates was performed and compared to non-invasive (n = 517) isolates. Clinical data of notified iGAS was obtained from the national infectious disease information system. Annual incidences of iGAS cases (n = 561) were 2.33-3.66 per 100,000 population. Bacteraemia was the most common clinical presentation (75%) followed by focus without bacteraemia (19%) and necrotizing faciitis (7%). Streptococcal toxic shock syndrome occurred in 19% of presentations. The main invasive emm types in rank order were emm1, emm3, emm28, emm12 and emm89 whereas emm4, emm28, emm3, emm12, emm89 and emm1 predominated in non-invasive infections. Invasive emm1 and emm3 showed annual fluctuations (15-48% and 4-37%, respectively) and predominated in most clinical presentations of iGAS. Superantigens speA, speG, speJ was associated with iGAS disease and, speC, speI and ssa with non-invasive infections. There was 4.3% erythromycin and 5.6% tetracycline resistance. The main resistant types were emm11, emm28 and emm77. Cyclic increases in emm1 and emm3 occurred during the iGAS upsurge. Continued surveillance of GAS is therefore essential given the epidemiological changes that occur in a short time period.

Surveillance of Antibiotic Resistance Among Enterobacteriaceae Strains Isolated in an Infectious Diseases Hospital from Romania

The aim of the present study was to characterize the antibiotic resistance profile of enterobacteriaceae strains isolated in Infectious Diseases Hospital Galati, Romania, during 2016, in order to guide the local antibiotic stewardship strategy. There are 597 biological samples with positive cultures for enterobacteriaceae, related to invasive and non-invasive infections. The main bacterial genus were E. coli 62%, Klebsiella spp 15%, Proteus spp 11% and Salmonella spp 6%. Over a half of isolated strains have one or more antibiotic resistance. The resistance level depends on bacterial genus, with highest level found among the rare isolates: Enterobacter spp, Citrobacter spp, Morganella spp and Serratia spp. The rate of MDR was 17.,6% for E. coli, 40.9% for Klebsiella spp and 50.7% for Proteus spp. while the rate of strains producing Extended Spectrum of Beta Lactamase are 7.2% for E. coli, 28.4% for Klebsiella spp and 12.3% for Proteus spp. The carbapenem resistant strains were found in 1.1% cases.

Prolonged and large outbreak of invasive group A Streptococcus disease within a nursing home: repeated intrafacility transmission of a single strain

ObjectivesMultiple invasive group A Streptococcus (GAS) infections were reported to public health by a skilled nursing facility (facility A) in Illinois between May 2014 and August 2016. Cases continued despite interventions including antibiotic prophylaxis for all residents and staff. Two other geographically close facilities reported contemporaneous outbreaks of GAS. We investigated potential reasons for ongoing transmission. MethodsWe obtained epidemiologic data from chart review of cases and review of facility and public health records from previous investigations into the outbreak. Infection control practices at facility A were observed and evaluated. Whole genome sequencing followed by phylogenetic analysis was performed on available isolates from the three facilities. ResultsFrom 2014 to 2016, 19 invasive and 60 noninvasive GAS infections were identified at facility A occurring in three clusters. Infection control evaluations during clusters 2 and 3 identified hand hygiene compliance rates of 14% to 25%, appropriate personal protective equipment use in only 33% of observed instances, and deficient wound-care practices. GAS isolates from residents and staff of all three facilities were subtype emm89.0; on phylogenetic analysis, facility A isolates were monophyletic and distinct. ConclusionsInadequate infection control and improper wound-care practices likely led to this 28-month-long outbreak of severe infections in a skilled nursing facility. Whole genome sequencing and phylogenetic analysis suggested that intrafacility transmission of a single highly transmissible GAS strain was responsible for the outbreak in facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.

Characterization of group B Streptococcus isolated from sterile and non-sterile specimens in China

Group B streptococcus (GBS) is a leading cause of invasive neonatal infections and has increasingly been associated with invasive diseases in non-pregnant adults. We collected 113 GBS isolates recovered from sterile and non-sterile specimens from seven tertiary hospitals in China between October 2014 and September 2016. Medical records were retrospectively reviewed and the sequence types, serotypes, virulence, and antimicrobial resistance profiles of the isolates were characterized and correlated. Significantly higher C-reactive protein and procalcitonin levels and absolute neutrophil counts were observed in patients with invasive infections than in those with non-invasive infections (P < 0.05). The 113 isolates were grouped into 24 sequence types, 5 clonal complexes, and 6 serotypes. multivariate analysis revealed that clonal complex 17 isolates characterized by serotype iii, the surface protein gene rib, and the pilus island pi-2b were independently correlated with invasive infection (or: 6.79; 95% ci: 2.31–19.94, P < 0.001). These results suggest alternative molecular biomarkers for diagnosis and prognosis of GBS infections.