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A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire

Published online by Cambridge University Press:  15 May 2009

K. Cartwright ,
M. Logan ,
C. McNulty ,
S. Harrison ,
R. George ,
A. Efstratiou ,
M. McEvoy  and
N. Begg
K. Cartwright
Affiliation:
Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
M. Logan
Affiliation:
Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
C. McNulty
Affiliation:
Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
S. Harrison
Affiliation:
PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
R. George
Affiliation:
Streptococcus and Diphtheria Reference Laboratory, PHLS Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5EQ
A. Efstratiou
Affiliation:
Streptococcus and Diphtheria Reference Laboratory, PHLS Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5EQ
M. McEvoy
Affiliation:
PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
N. Begg
Affiliation:
PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ
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Summary

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We describe the first cluster of cases of necrotizing fasciitis (NF) in this century in the United Kingdom (UK). Between 1 January and 30 June 1994 there were six cases (five confirmed, one probable) of Streptococcus pyogenes NF in west Gloucestershire, population 320000. Two cases died. The first two patients probably acquired their infections during the course of elective surgery performed in the same operating theatre, possibly from a nasopharyngeal carrier amongst the theatre staff. The remaining infections were community-acquired. Of 5 S. pyogenes isolates there were 2 M1 strains, 1 M3, 1 M5 and 1 M non-typeable strain. S. pyogenes NF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence of S. pyogenes bacteraemia in England and Wales had not risen in the past 5 years.

The two presumably theatre-acquired infections raised several issues. The need for detailed bacteriological investigation of all cases of post-surgical NF was confirmed. Clusters of S. pyogenes infection following surgery should be managed by closure of the operating theatre until all staff have been screened for carriage. Closure of an operating theatre and screening of staff following a sporadic case is probably not justified because of the infrequency of surgical cross-infection with S. pyogenes. Regular, routine screening of theatre staff is neither practical nor necessary.

Type
Research Article
Information
Epidemiology & Infection , Volume 115 , Issue 3 , December 1995 , pp. 387 - 397
Copyright
Copyright © Cambridge University Press 1995

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