Methods: A retrospective review at a 1200 bed tertiary care medical center identified five cases of postpartum GAS over a 14 month period. A case was defined as: isolation of GAS from a sterile site or a surgical wound during the hospital stay or within 28 days after discharge. For each case, the medical record was immediately reviewed to identify risk factors for acquisition, the likely source, treatment and subsequent clinical course. An epidemiological investigation was conducted which involved interviewing each patient regarding sick contacts and history of skin/soft tissue infections, obtaining oropharyngeal (O/P), rectal and vaginal cultures, as well as potentially screening involved HCWs for carriage of GAS. Isolates from each case were typed using pulsed-field gel electrophoresis (PFGE) for comparison.
Results: The first patient had a GAS cesarean incisional infection, but negative vaginal, rectal and O/P screening swabs. Seventeen associated HCW were screened at O/P and rectal sites, and none were positive for GAS. Of the other four patients, three had GAS bacteremia, two had positive urine cultures and one had endometritis. All four were positive for GAS carriage from vaginal/cervical sites, indicating likely colonization prior to admission, thus no additional HCWs have been screened. All five patients recovered quickly with appropriate treatment. Of the three isolates typed by PFGE to date, none were related. Typing of the two most recent isolates is pending.
Conclusion: An extensive epidemiological investigation found no evidence that these GAS infections were cross transmitted, hospital acquired, nor associated with HCW. Given the potential for significant morbidity caused by GAS, surveillance is ongoing by microbiology, epidemiology, obstetrics and gynecology, and infectious diseases.
J. Mangino, None