DiPersio JR, File Jr. TM, Stevens DL, et al.Spread of serious disease-producing M3 clones of group A streptococcus among family members and health care workers.Clinical Infect Dis1996; 22:490-495.

Documenting transmission of group A streptococcus to both family members of infected patients and the health care workers who were treating them, the authors advise implementing infection control measures for a pathogen that can cause invasive disease.

Streptococcus pyogenes causes a variety of diseases ranging from mild pharyngitis to severe toxic shock syndrome (TSS) and acute rheumatic fever. Since 1987, there has been a resurgence of severe group A strep infections including TSS and necrotizing fasciitis. Using molecular and serotyping procedures, the authors confirmed two clusters of group A strep disease that occurred within separate family units. One cluster involved two family members -- one with TSS and one with necrotizing fasciitis -- and led to pharyngitis infections in three health care workers who treated the latter.

The findings enforce the need for barrier protection when health care workers are exposed to secretions from infected individuals. Gloves and gowns should be worn during contact with patients with group A strep wound infections.

"It is also possible that patients with overwhelming infection, such as necrotizing fasciitis, may be capable of spreading the infection via the airborne route," the authors state. "We speculate that the health care providers who had pharyngeal infection . . . may have acquired their infections in this manner. Assuming this to be true, appropriate infection control measures should perhaps include the wearing of masks during the care of a patient with suspected rapidly spreading group A streptococcus necrotizing fasciitis."

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Fagon Jean-Yves, Chastre J, Vaugnat A, et al. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996; 275:866-869.

While severity of underlying medical conditions and severity of patient illness are factors, the authors concluded that nosocomial pneumonia infections can be singled out as a cause of patient mortality in intensive care units.

The exact role nosocomial infections play in worsening the prognosis of ICU patients is difficult to assess, as such patients are critically ill and their clinical status is severe enough to require intensive care and potentially to cause death, they note.

To evaluate the role that nosocomial pneumonia plays in the outcome of ICU patients, they conducted a cohort study of 1,978 consecutive patients at a French hospital. Various parameters known to be strongly associated with death of ICU patients were recorded, including age, severity of illness, and the development of nosocomial bacteremia and nosocomial urinary tract infection. Those variables and the presence or absence of nosocomial pneumonia were compared between survivors and non-survivors. Nosocomial pneumonia developed in 328 patients (16.6%), whose mortality rate was 52.4%. ICU patients who did not develop nosocomial pneumonia had a mortality rate of 22.4%.

"Our data demonstrate that nosocomial pneumonia is independently associated with deaths of ICU patients, in addition to deaths attributable to the severity of overall clinical status or nosocomial bacteremia," the authors conclude. "These findings suggest that an effective strategy for preventing nosocomial infections in the ICU could succeed in significantly reducing mortality."

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Reichlere MR, Rakovsky J, Slacikova M, et al. Spread of multidrug-resistant Streptococcus pneumoniae among hospitalized children in Slovakia. J Infect Dis 1996; 173:374-379.

The explosion of drug-resistant Streptococcus pneumoniae in the United States in recent years has raised questions about whether the pathogen may begin causing nosocomial outbreaks. In a report that may shed light on that question, the authors document transmission of a multidrug-resistant strain of strep pneumo in a hospital in eastern Czechoslovakia. The resistant strain was isolated from cultures of eight of 24 colonized children at the hospital. One-quarter of the initially uncolonized children at the hospital acquired the resistant strain during hospitalization. Among hospitalized children, frequent antimicrobial drug use was associated with infection with the resistant strain. Those findings support limiting broad-spectrum antimicrobial drug use and nonessential hospitalizations in settings where drug-resistant pneumococci are prevalent. Development of a pneumococcal vaccine that is immunogenic in young children is urgently needed, the authors report.

"Transmission of a multiply drug-resistant pneumococcal strain . . . among hospitalized children is of substantial importance because of the demonstrated potential of this strain to cause invasive disease, the presence in hospitals of many persons with altered susceptibility to infection, and the potential risk of spread into the surrounding community," the authors conclude.

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Hussain M, Oppenheim BA, O'Neill P, et al. Prospective survey of the incidence, risk factors and outcome of hospital-acquired infections in the elderly. J Hosp Infect 1996; 32:117-126.

Nosocomial infections are common among patients age 65 and older, as nearly one-fifth of the patients studied became infected following admission, the authors report.

Researchers in the United Kingdom followed 486 patient admissions to two different wards, finding 113 nosocomial infections occurred in 81 (18.5%) of the patients following admission. The chest and urinary tract were the most common sites of infection, and 26 patients appeared to be infected at more than one site. The majority of first infections occurred within 14 days of admission. Median length of stay for patients with one or more infective episodes was significantly longer than for those who did not develop an infection. The presence of a nosocomial infection, multiple-site infections, and chest infections were significantly associated with fatal outcomes.

"Hospital-acquired infection occurs commonly in elderly patients and is associated with prolonged hospital stay and increased mortality," the authors conclude. ". . . Our overall infection rates appear to be similar to those noted for elderly patients in chronic care facilities in the United States." *