2Outbreak Summary Report 2012-235perforation, pulmonary or arterial embolism, hemorrhage, cardiac arrest, shock, pulmonary edema,infection, and sepsis
(GAS) is a gram-positive bacterium that is most often detected in the throat andon the skin. These bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin. The bacteriacan also be carried by asymptomatic individuals (called “carriers”) for long periods of time, and whilecarriers are less contagious than those with active infection, they are still capable of transmitting thebacterium that can cause disease. Most GAS infections are relatively mild. The most common GASinfections are “strep throat” and impetigo, a mild skin infection. Occasionally these bacteria can causesevere and even life-threatening diseases when they infect normally sterile body sites, such as blood,muscle, or the lungs, resulting in a condition called “invasive GAS”. Examples of forms of invasive GASare necrotizing fasciitis and streptococcal toxic shock syndrome. Risk factors for invasive GAS includediabetes, drug use, immunosuppression, recent surgery, and traumatic wounds. Mortality rates of invasive GAS are 10-15%. There is approximately a 25% mortality rate associated with invasive infectionresulting in necrotizing fasciitis. Antibiotics can be used to treat both mild and invasive infections. Forthose with invasive disease, treatment in an intensive care unit and surgery to remove damaged tissuemay be necessary. About 9,000-11,500 cases of invasive GAS infections occur each year in the UnitedStates, resulting in 1,000-1,800 deaths annually.
Invasive GAS is a reportable condition in Maryland. Upon diagnosis of a case of invasive GAS, cliniciansand/or laboratories submit a report to their local health department for entry into the Marylandnotifiable disease database. Between 2007-2011, there were 946 total cases of invasive GAS inMaryland, and an average of 189 cases of invasive GAS are reported annually.
In the healthcare setting, surgical and obstetric patients are most vulnerable to GAS due to the break inmucosal or cutaneous barriers that occurs during these procedures. Group A Strep infection followingsurgery and childbirth is still a very rare occurrence, with GAS being the cause of only 1% of all surgicalsite infections, and 3% of infections after vaginal delivery. Since 1965, there have been at least 15 post-op or post-partum outbreaks of GAS infections attributed to asymptomatic carriage in healthcareworkers.
Appropriate infection control measures may help prevent or interrupt transmission from healthcareworker to patient. In addition, per Centers for Disease Control and Prevention (CDC) guidance, once apostsurgical or postobstetrical patient is suspected or identified with GAS, enhanced surveillance andepidemiologic investigation should immediately follow. Screening of all healthcare workers present inthe procedure room, as well as those who had some kind of contact with open wounds, should takeplace. Recommended body sites for screening include the nares, throat, vagina, rectum, and skin.
Lehnhardt M et al. Major and Lethal Complications of Liposuction: A Review of 72 Cases in Germany between1998 and 2002, Plastic and Reconstructive Surgery, June 2008, 121(6), 396e-403e.
Unpublished DHMH data
MMWR Weekly Report, Mar 05, 1999, 48(08): 163-166