A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis

A 7-month outbreak of 15 cases of postpartum sepsis with group A haemolytic Streptococci (GAS) was stopped when a carrier was identified. Comparing de livery dates with duty rotas revealed that the carrier had been present dur ing delivery in 13 of the 15 cases. The epidemic GAS type, T3-13-B3264, was found in a carbuncle in her groin and in atopic dermatitis lesions behind her ears and on her eyelids. Thus, it was not the microbiological screening of staff that helped detect the carrier. The outbreak went unnoticed for 6 months, as no 2 cases were diagnosed by the same physician and 5 cases wer e diagnosed by different general practitioners. The main risk factors for i nfection were presence of the carrier relative risk (relative risk RR 47.8. 95% confidence interval (CI) 10.9-209.5) and suturing of episiotomy (RR 11 .0; 95% CI 2.6-47.9). We recommend that a thorough epidemiological investig ation should be carried out in every single case of GAS postpartum infectio n. Despite initial intravenous treatment with penicillin, 8 patients experi enced > 15 recurring postpartum GAS infections, such as endometritis, wound infection, tonsillitis, erysipelas and Brodie's abscess. Eradication of GA S should be confirmed after completion of treatment.