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O089: Recurrent transmission of group a streptococcus pyogenes (GAS) during surgery by a health care worker (HCW)
Antimicrobial Resistance and Infection Control volume 2, Article number: O89 (2013)
Surgical site infections (SSI) due to GAS are rare but potentially life-threatening.
We describe 2 cases occurring after thyroidectomy in two female patients (aged 36 and 52 years respectively), who developed septic shock with multi-organ failure, mediastinitis and empyema, respectively 2 and 4 days after surgery performed 4 months apart (Nov. 2009; Feb. 2010).
We interviewed patients or relatives and operating room (OR) personnel with regard to recent throat infection, and investigated SSI prevention measures, surgical masks wearing in the OR, and GAS carriage by HCWs; GAS isolates were compared by molecular typing.
There was no recent history of throat infection in patients or their relatives. Compliance to SSI preventive measures (pre operative showers, skin antisepsis, and laminar air flow) was adequate, and wearing of mask in the OR was adequate for 88% of 332 HCWs. A GAS isolate was recovered from throat swabs of 2 of the 6 HCWs caring for the 1st case, one of which was identical to the patient’s isolate. Auditing this HCW revealed a lack of adequate fitting of the mask during preparation of the OR. Educational sessions were implemented. After the 2nd case occurred, the same HCW was again found colonized with a GAS isolate identical to the patient’s isolate, but different from the 1st one. A more in-depth investigation revealed that one of his children had recurrent tonsillitis. Decolonization of the HCW was attempted, but GAS carriage recurred until tonsillectomy was performed on his child.
The same staff carrier was involved in the transmission of 2 different GAS strains, likely resulting from household transmission. Throat carriage of the personnel stopped only after tonsillectomy of his child. Reinforcing adequate surgical mask wearing in the OR is important, but 100% compliance appears difficult to maintain.
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Landelle, C., Lesprit, P., Legrand, P. et al. O089: Recurrent transmission of group a streptococcus pyogenes (GAS) during surgery by a health care worker (HCW). Antimicrob Resist Infect Control 2, O89 (2013). https://doi.org/10.1186/2047-2994-2-S1-O89
- Operating Room
- Surgical Site Infection
- Health Care Worker