A CLUSTER OF CASES OF STREPTOCOCCAL NECROTIZING FASCIITIS IN GLOUCESTERSHIRE

We describe the first cluster of cases of necrotizing fasciitis (NF) i n this century in the United Kingdom (UK). Between 1 January and 30 Ju ne 1994 there were six cases (five confirmed, one probable) of Strepto coccus pyogenes NF in west Gloucestershire, population 320000. Two cas es died. The first two patients probably acquired their infections dur ing the course of elective surgery performed in the same operating the atre, possibly from a nasopharyngeal carrier amongst the theatre staff . The remaining infections were community-acquired. Of 5 S. pyogenes i solates there were 2 M1 strains, 1 M3, 1 M5 and 1 M non-typeable strai n. S. pyogenes NF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence of S. pyogenes bacteraemia in En gland and Wales had not rises in the past 5 years. The two presumably theatre-acquired infections raised several issues. The need for detail ed 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 be en screened for carriage. Closure of an operating theatre and screenin g of staff following a sporadic case is probably not justified because of the infrequency of surgical cross-infection with S. pyogenes. Regu lar, routine screening of theatre staff is neither practical nor neces sary.