Smith Andrea, Li Aimin, Tolomeo Ornella, Tyrrell Gregory J, Jamieson Frances, Fisman David
City of Hamilton Social and Public Health Services Department, Hamilton, Ontario, Canada.
Emerg Infect Dis. 2003 Oct;9(10):1260-5. doi: 10.3201/eid0910.030130.
Outbreaks of invasive infections caused by group A β-hemolytic streptococcus (GAS) may occur in long-term care settings and are associated with a high case-fatality rate in debilitated adults. Targeted antibiotic treatment only to residents and staff known to be at specific risk of GAS may be an ineffective outbreak control measure. We describe two institutional outbreaks in which mass antibiotic treatment was used as a control measure. In the first instance, mass treatment was used after targeted antibiotic treatment was not successful. In the second instance, mass treatment was used to control a rapidly evolving outbreak with a high case-fatality rate. Although no further clinical cases were seen after the introduction of mass antibiotic treatment, persistence of the outbreak strain was documented in one institution >1 year after cases had ceased. Strain persistence was associated with the presence of a chronically colonized resident and poor infection control practices.
A组β溶血性链球菌（GAS）引起的侵袭性感染暴发可能发生在长期护理机构中，并且在体弱的成年人中具有较高的病死率。仅对已知有GAS特定感染风险的居民和工作人员进行针对性抗生素治疗可能是一种无效的疫情控制措施。我们描述了两起机构性疫情，其中采用了大规模抗生素治疗作为控制措施。在第一起疫情中，在针对性抗生素治疗未成功后采用了大规模治疗。在第二起疫情中，大规模治疗用于控制病死率高且迅速演变的疫情。尽管在引入大规模抗生素治疗后未再出现临床病例，但在一个机构中，疫情菌株在病例停止>1年后仍有留存记录。菌株留存与一名长期定植的居民的存在以及不良的感染控制措施有关。
