Dolan Gayle, Coelho Juliana, Ryan Yan, Scott Angela, Milburn Melanie, Settle Chris, Lamagni Theresa
North East Health Protection Team, Chief Medical Advisor's Group, UK Health Security Agency, Newcastle, UK.
Healthcare Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, UK.
Antimicrob Steward Healthc Epidemiol. 2025 Mar 17;5(1):e79. doi: 10.1017/ash.2025.44. eCollection 2025.
Outbreaks of Group A Streptococcal (GAS) infection are difficult to detect in community healthcare settings and present unique challenges for infection prevention and control (IPC). We describe investigation of a cluster of GAS among individuals receiving wound care from the same community integrated care team (CIT) and associated complexities.
Prospective and retrospective surveillance for cases of invasive and noninvasive GAS infection linked to the CIT was undertaken with the local NHS trust IPC team. Screening samples were requested from staff working in the CIT (n = 191) and from staff and residents (n = 73) in care home A where several cases resided. Clinical isolates were sent to the UKHSA reference laboratory for typing and whole genome sequencing (WGS).
Twenty-two cases were identified over a five-month period. Eighteen had isolates available for typing, 11 of which were type 108.1 and 0-2SNPs apart on WGS. Six were different types and one type 108.1 but 9-13SNPs apart from other isolates and so excluded from the investigation. No staff infected or colonized with 108.1 were identified, and no single healthcare worker had attended all cases. GAS was isolated in the room of a case resident in care home A and found to be closely genetically related to clinical isolates.
WGS was integral in identifying outbreak cases and a multiagency approach essential to the investigation. Unfortunately, despite this no clear source or route of transmission was identified. Further research is required to determine the most effective IPC strategies for community healthcare.
A 组链球菌（GAS）感染的暴发在社区医疗机构中难以察觉，给感染预防与控制（IPC）带来了独特挑战。我们描述了对同一社区综合护理团队（CIT）提供伤口护理的个体中 GAS 聚集性感染的调查及相关复杂性。
与当地国民保健服务信托基金的 IPC 团队对与 CIT 相关的侵袭性和非侵袭性 GAS 感染病例进行前瞻性和回顾性监测。要求 CIT 的工作人员（n = 191）以及数例病例所在的护理院 A 的工作人员和居民（n = 73）提供筛查样本。临床分离株被送往英国卫生安全局参考实验室进行分型和全基因组测序（WGS）。
在五个月期间共识别出 22 例病例。18 例有可用于分型的分离株，其中 11 例为 108.1 型，在 WGS 上相差 0 - 2 个单核苷酸多态性（SNP）。6 例为不同类型，1 例为 108.1 型，但与其他分离株相差 9 - 13 个 SNP，因此被排除在调查之外。未发现感染或定植 108.1 型的工作人员，也没有单一医护人员照料过所有病例。在护理院 A 中一名病例居住的房间内分离出 GAS，发现其与临床分离株在基因上密切相关。
WGS 在识别暴发病例中不可或缺，多机构方法对调查至关重要。遗憾的是，尽管如此，仍未确定明确的感染源或传播途径。需要进一步研究以确定社区医疗保健中最有效的 IPC 策略。
