1411. A protracted outbreak of invasive Group A Streptococcal (iGAS) infection at a UK long term facility iinvestigated using whole genome sequencing
Session: Poster Abstract Session: HAI: Outbreaks
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Poster_1411_Gossain_ A protracted outbreak of invasive Group A streptococcal (IGAS) infection in a UK long term care facility investigated using whole genome sequencing.pdf (2.6 MB)
  • Background: In May 2014, two cases of invasive Group A streptococcal infection (iGAS), of the same uncommon type (emm ST 5.23), were noted in the nursing unit of a large UK care home. All residents in this unit were given antibiotic chemoprophylaxis to prevent further cases. In September 2014, a third iGAS case of the same subtype was identified in another unit of the same care home. Staff and residents were screened for carriage with no positives found. Two further iGAS cases in early 2015 prompted further investigation.

    Methods: All Care home residents and staff were screened in February/March 2015 for throat (and skin lesions if present) carriage of GAS using standard microbiological methods. Environmental sampling was also undertaken. Following screening, 21 isolates of GAS emm ST 5.23 were available from the Care Home for further analysis (11 residents, 9 staff members and 1 environmental isolate). Two additional isolates (1 staff & 1 resident) were excluded from further analysis as they were of different emm type. Genome sequence data was obtained (Illumina) for these and an additional 30 emm ST 5 lineage isolates from 2014 -2015 from varying geographical locations in England/Wales/Ireland, including invasive isolates. All isolates included in the study passed quality and coverage checks. The emm ST5 lineage reference strain Manfredo_M5 was used to map genomic sequence data


    Results:
    All isolates from the care home located within the same phylogenetic clade in addition to isolates from other geographical UK regions sequenced. However all 2015 care home isolates co-located to a distinct phylogenetic sub-branch, proximal to the 2014 isolates. Strains from staff, patients and the environmental isolate were in some cases indistinguishable.


    Conclusion:
    Several residents, staff and a chair in the clinical room were found to have indistinguishable GAS isolates suggesting persistence of the strain within the care home over a 10 month period. However local contemporaneous strains were not available for comparison so reintroduction into the home cannot be discounted. The outbreak was brought to an end by several outbreak control measures including environmental cleaning with steam and chlorine-based agents as well as antibiotic chemoprophylaxis for all staff and residents administered in March 2015.

    Savita Gossain, BSc.; MB.BS; FRCPath1, Vicki Chalker, PhD2, Georgia Kapatai, PhD2, Juliana Coelho, PhD2, Huda Mohamed, MBBS, MCH, MPH FFPH MFPH3, Katherine Martin, PhD3 and Mamoona Tahir, MBBS, MPH, FFPH, MFPH3, (1)Public Health Laboratory,, Birmingham, United Kingdom, (2)National Infection Service, Public Health England, London, United Kingdom, (3)Public Health England, Birmingham, United Kingdom

    Disclosures:

    S. Gossain, None

    V. Chalker, None

    G. Kapatai, None

    J. Coelho, None

    H. Mohamed, None

    K. Martin, None

    M. Tahir, None

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