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Degala S, Puleston R, Bates R, Borges-Stewart R, Coelho J, Kapatai G, Chalker V, Mair-Jenkins J. A protracted iGAS outbreak in a long-term care facility 2014-2015: control measures and the use of whole-genome sequencing. J Hosp Infect 2021; 105:70-77. [PMID: 32386676 DOI: 10.1016/j.jhin.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND In 2014, two residents of a long-term care facility (LTCF) developed invasive group A streptococcal (iGAS) infections with identical typing (emm 11), resulting in one death. The second resident recovered but had a subsequent episode of emm 11 iGAS infection 10 months later. This second episode was linked to a third case, within 12 days, leading to a further outbreak investigation. AIM To combine different techniques to establish whether this was a protracted outbreak, understand transmission pathways and inform appropriate control measures. METHODS Following a routine response to the first cluster, the second investigation included a care record review. This informed network analysis of case interactions with staff and visitors during 10 days prior to infection. These data were combined with post-outbreak whole-genome sequencing (WGS) using isolates from cases, and staff and resident screening (44 GAS isolates: 11 outbreak-related and 33 sporadic isolates). FINDINGS Two of the three confirmed iGAS cases died (one suffered two episodes). All iGAS cases, and six non-invasive isolates from 2015, were emm 11 (monophylogenetic WGS clade). Network analysis highlighted only indirect contact through staff-visitor interactions between iGAS cases in 2015. This suggested a common source and transmission propagation through carriage and/or environmental contamination over an 11-month period. CONCLUSIONS This outbreak highlighted benefits of staff/resident screening and typing as part of routine response. Network analysis and highly discriminatory WGS clarified the protracted nature of the outbreak, supporting findings of hygiene and infection control issues and adding to our understanding of the epidemiology.
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Affiliation(s)
- S Degala
- Field Epidemiology, Field Service, National Infection Service, Public Health England, Nottingham, UK.
| | - R Puleston
- Field Epidemiology, Field Service, National Infection Service, Public Health England, Nottingham, UK
| | - R Bates
- Local Knowledge and Intelligence Service, Public Health England, Nottingham, UK
| | | | - J Coelho
- Respiratory and Systemic Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Nottingham, UK
| | - G Kapatai
- Respiratory and Systemic Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Nottingham, UK
| | - V Chalker
- Respiratory and Systemic Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Nottingham, UK
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Jermacane D, Coope CM, Ironmonger D, Cleary P, Muller-Pebody B, Hope R, Hopkins S, Puleston R, Freeman R, Hopkins KL, Johnson AP, Woodford N, Oliver I. An evaluation of the electronic reporting system for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria in England. J Hosp Infect 2019; 102:17-24. [PMID: 30641097 DOI: 10.1016/j.jhin.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND An electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria (CPGNB) was launched by Public Health England in May 2015. AIM This evaluation aimed to assess uptake, timeliness and completeness of data provided and explore potential barriers and facilitators to adopting the system. METHODS The evaluation comprised a retrospective analysis of surveillance data and semi-structured interviews with ERS users. FINDINGS The proportion of organisms referred for investigation of carbapenem resistance via ERS increased over the first 12 months post-implementation from 35% to 73%; uptake varied widely across regions of England. Completeness of enhanced data fields was poor in 78% of submitted isolates. The median number of days to report confirmatory test results via ERS was 1 day for the regional service and nine days for the national reference laboratory, which additionally conducts phenotypic testing to confirm carbapenemase negativity. Hindrances to ERS utility included: a lack of designated, ongoing resource for system maintenance, technical support and development; uncertainty about how and when to use ERS and workload. Incomplete data prevented gaining a better understanding of important risk factors and transmission routes of CPGNB in England. CONCLUSION The ERS is the only surveillance system in England with the potential to gather intelligence on important risk factors for CPGNB to inform public health measures to control their spread. Although the ERS captures more information on CPGNB than other surveillance systems, timeliness and completeness of the enhanced data require substantial improvements in order to deliver the desired health benefits.
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Affiliation(s)
- D Jermacane
- Field Service, National Infection Service, Public Health England, UK
| | - C M Coope
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
| | - D Ironmonger
- Field Service, National Infection Service, Public Health England, UK
| | - P Cleary
- Field Service, National Infection Service, Public Health England, UK
| | - B Muller-Pebody
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Hope
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - S Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Puleston
- Field Service, National Infection Service, Public Health England, UK
| | - R Freeman
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - K L Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - A P Johnson
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - N Woodford
- National Infection Service Laboratories, Public Health England, London, UK
| | - I Oliver
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
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Decraene V, Ghebrehewet S, Dardamissis E, Huyton R, Mortimer K, Wilkinson D, Shokrollahi K, Singleton S, Patel B, Turton J, Hoffman P, Puleston R. An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service in the North of England: challenges of infection prevention and control in a complex setting. J Hosp Infect 2018; 100:e239-e245. [DOI: 10.1016/j.jhin.2018.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022]
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Freeman R, Ironmonger D, Puleston R, Hopkins K, Welfare W, Hope R, Staves P, Shemko M, Hopkins S, Cleary P, Patel B, Muller-Pebody B, Li X, Alvarez-Buylla A, Hawkey P, Johnson A, Woodford N, Oliver I. Enhanced surveillance of carbapenemase-producing Gram-negative bacteria to support national and international prevention and control efforts. Clin Microbiol Infect 2016; 22:896-897. [DOI: 10.1016/j.cmi.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
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5
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Paranthaman K, Bentley A, Milne LM, Kearns A, Loader S, Thomas A, Thompson F, Logan M, Newitt S, Puleston R. Nosocomial outbreak of staphyloccocal scalded skin syndrome in neonates in England, December 2012 to March 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 25166346 DOI: 10.2807/1560-7917.es2014.19.33.20880] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Staphylococcal scalded skin syndrome (SSSS) is a blistering skin condition caused by exfoliative toxin-producing strains of Staphylococcus aureus. Outbreaks of SSSS in maternity settings are rarely reported. We describe an outbreak of SSSS that occurred among neonates born at a maternity unit in England during December 2012 to March 2013. Detailed epidemiological and microbiological investigations were undertaken. Eight neonates were found to be infected with the outbreak strain of S. aureus, of spa type t346, representing a single pulsotype. All eight isolates contained genes encoding exfoliative toxin A (eta) and six of them contained genes encoding toxin B (etb). Nasal swabs taken during targeted staff screening yielded a staphylococcal carriage rate of 21% (17/80), but none contained the outbreak strain. Mass screening involving multi-site swabbing and pooled, enrichment culture identified a healthcare worker (HCW) with the outbreak strain. This HCW was known to have a chronic skin condition and their initial nasal screen was negative. The outbreak ended when they were excluded from work. This outbreak highlights the need for implementing robust swabbing and culture methodswhen conventional techniques are unsuccessful in identifying staff carrier(s). This study adds to the growing body of evidence on the role of HCWs in nosocomial transmission of S. aureus.
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Affiliation(s)
- K Paranthaman
- Public Health England, East Midlands Public Health England Centre, Leicester, United Kingdom
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Ashiru-Oredope D, Kessel A, Hopkins S, Ashiru-Oredope D, Brown B, Brown N, Carter S, Charlett A, Cichowka A, Faulding S, Gallagher R, Johnson A, McNulty C, Moore M, Patel B, Puleston R, Richman C, Ridge K, Robotham J, Sharland M, Stephens P, Stokle L, Towers K, Underhill J, West T, Whitney L, Wight A, Woodford N, Young T. Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). J Antimicrob Chemother 2013; 68:2421-3. [DOI: 10.1093/jac/dkt363] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Puleston R, Beck C, Tahir M, Bardhan M, Charlemagne P, Alves C, Ladhani S, Watson C, Ramsay M, Kaczmarksi E, Borrow R, Gray S, Hadlington D, Weinbren M, Bhattacharjee D, Inglis N. An unusual transmission event of Neisseria meningitidis serogroup W135 type 2a in a healthcare setting, England, 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.44.20308-en] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report an outbreak of Neisseria meningitidis serogroup W135, associated with a transient transmission event between asymptomatic individuals in a healthcare setting. Two elderly persons subsequently developed invasive meningococcal disease. The duration and type of close contact for those directly involved in the probable transmission incident would not have warranted chemoprophylaxis according to current guidelines. Meningococcal infection in older persons usually presents with pneumonia rather than meningitis or septicaemia with purpura.
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Affiliation(s)
- R Puleston
- Health Protection Agency, Nottingham, United Kingdom
| | - C Beck
- Health Protection Agency, Nottingham, United Kingdom
| | - M Tahir
- Health Protection Agency, Birmingham, United Kingdom
| | - M Bardhan
- Health Protection Agency, Birmingham, United Kingdom
| | - P Charlemagne
- Health Protection Agency, Birmingham, United Kingdom
| | - C Alves
- Health Protection Agency, Birmingham, United Kingdom
| | - S Ladhani
- Health Protection Agency, London, United Kingdom
| | - C Watson
- Health Protection Agency, London, United Kingdom
| | - M Ramsay
- Health Protection Agency, London, United Kingdom
| | - E Kaczmarksi
- Meningococcal Reference Unit, Health Protection Agency, Public Health Laboratory, Manchester, United Kingdom
| | - R Borrow
- Meningococcal Reference Unit, Health Protection Agency, Public Health Laboratory, Manchester, United Kingdom
| | - S Gray
- Meningococcal Reference Unit, Health Protection Agency, Public Health Laboratory, Manchester, United Kingdom
| | - D Hadlington
- West Midlands Ambulance Service, West Midlands, United Kingdom
| | - M Weinbren
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - D Bhattacharjee
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - N Inglis
- NHS Coventry and Warwickshire, Coventry, United Kingdom
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Puleston R, Beck C, Tahir M, Bardhan M, Charlemagne P, Alves C, Ladhani S, Watson C, Ramsay M, Kaczmarksi E, Borrow R, Gray S, Hadlington D, Weinbren M, Bhattacharjee D, Inglis N. An unusual transmission event of Neisseria meningitidis serogroup W135 type 2a in a healthcare setting, England, 2012. Euro Surveill 2012; 17:20308. [PMID: 23137486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- R Puleston
- Health Protection Agency, Nottingham, United Kingdom.
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