Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit
Background: The clinical manifestations of Group A streptococcus (GAS) – (Streptococcus pyogenes) are diverse, ranging from asymptomatic colonisation to devastating invasive disease. Maternity related clusters of invasive Group A streptococcus (iGAS) infection are complex to investigate and control...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018
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| Online Access: | https://eprints.nottingham.ac.uk/51180/ |
| _version_ | 1848798435995549696 |
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| author | Dickinson, Harriet Reacher, Mark Nazareth, Bernadette Eagle, Heidi Fowler, Deirdre Underwood, Anthony Chand, Meera Chalker, Victoria Coelho, Juliana Daniel, Roger Kapatai, Georgia Al-Shabib, Ali Puleston, Richard |
| author_facet | Dickinson, Harriet Reacher, Mark Nazareth, Bernadette Eagle, Heidi Fowler, Deirdre Underwood, Anthony Chand, Meera Chalker, Victoria Coelho, Juliana Daniel, Roger Kapatai, Georgia Al-Shabib, Ali Puleston, Richard |
| author_sort | Dickinson, Harriet |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: The clinical manifestations of Group A streptococcus (GAS) – (Streptococcus pyogenes) are diverse, ranging from asymptomatic colonisation to devastating invasive disease. Maternity related clusters of invasive Group A streptococcus (iGAS) infection are complex to investigate and control, especially if recurrent.
Aim: We report on the investigation into three episodes of emm 75 GAS/iGAS infection in maternity patients at one hospital site over a 4 year period, two with monophyletic ancestry.
Methods: The episodes are described, together with whole genome sequence isolate analyses. Single nucleotide polymorphism differences were compared with contemporaneous emm 75 genomes.
Findings: Seven mothers had GAS/iGAS in over a 4 year period, emm 75, S.pyogenes and one had iGAS (in year 4) emm 3, S.pyogenes (subsequently discounted as linked). Three (clinical/screening samples) of the seven babies of emm 75 positive mothers and 3 screened healthcare workers were positive for GAS emm 75. Whole genome sequence similarity suggests a shared ancestral lineage and suggested a common source transmission but directionality of transmission cannot be inferred. However the findings indicate that persistence of a particular clone in a given setting may be long-term.
Conclusions: Occupational health procedures were enhanced, staff were screened and antibiotic therapy provided to GAS positive staff and patients. The definitive source of infection could not be identified, although staff/patient transmission is the most likely route. The pattern of clonal GAS transmission over 4 years suggests long-term persistence of GAS may have occurred. |
| first_indexed | 2025-11-14T20:19:44Z |
| format | Article |
| id | nottingham-51180 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T20:19:44Z |
| publishDate | 2018 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-511802019-03-22T04:30:18Z https://eprints.nottingham.ac.uk/51180/ Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit Dickinson, Harriet Reacher, Mark Nazareth, Bernadette Eagle, Heidi Fowler, Deirdre Underwood, Anthony Chand, Meera Chalker, Victoria Coelho, Juliana Daniel, Roger Kapatai, Georgia Al-Shabib, Ali Puleston, Richard Background: The clinical manifestations of Group A streptococcus (GAS) – (Streptococcus pyogenes) are diverse, ranging from asymptomatic colonisation to devastating invasive disease. Maternity related clusters of invasive Group A streptococcus (iGAS) infection are complex to investigate and control, especially if recurrent. Aim: We report on the investigation into three episodes of emm 75 GAS/iGAS infection in maternity patients at one hospital site over a 4 year period, two with monophyletic ancestry. Methods: The episodes are described, together with whole genome sequence isolate analyses. Single nucleotide polymorphism differences were compared with contemporaneous emm 75 genomes. Findings: Seven mothers had GAS/iGAS in over a 4 year period, emm 75, S.pyogenes and one had iGAS (in year 4) emm 3, S.pyogenes (subsequently discounted as linked). Three (clinical/screening samples) of the seven babies of emm 75 positive mothers and 3 screened healthcare workers were positive for GAS emm 75. Whole genome sequence similarity suggests a shared ancestral lineage and suggested a common source transmission but directionality of transmission cannot be inferred. However the findings indicate that persistence of a particular clone in a given setting may be long-term. Conclusions: Occupational health procedures were enhanced, staff were screened and antibiotic therapy provided to GAS positive staff and patients. The definitive source of infection could not be identified, although staff/patient transmission is the most likely route. The pattern of clonal GAS transmission over 4 years suggests long-term persistence of GAS may have occurred. Elsevier 2018-03-22 Article PeerReviewed application/pdf en cc_by_nc_nd https://eprints.nottingham.ac.uk/51180/1/20180307RecurrentiGASMaternityUnitRevision1.0%20%28002%29.pdf Dickinson, Harriet, Reacher, Mark, Nazareth, Bernadette, Eagle, Heidi, Fowler, Deirdre, Underwood, Anthony, Chand, Meera, Chalker, Victoria, Coelho, Juliana, Daniel, Roger, Kapatai, Georgia, Al-Shabib, Ali and Puleston, Richard (2018) Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit. Journal of Hospital Infection . ISSN 1532-2939 (In Press) iGAS Streptococcus maternity whole genome sequencing https://www.sciencedirect.com/science/article/pii/S0195670118301695 doi:10.1016/j.jhin.2018.03.018 doi:10.1016/j.jhin.2018.03.018 |
| spellingShingle | iGAS Streptococcus maternity whole genome sequencing Dickinson, Harriet Reacher, Mark Nazareth, Bernadette Eagle, Heidi Fowler, Deirdre Underwood, Anthony Chand, Meera Chalker, Victoria Coelho, Juliana Daniel, Roger Kapatai, Georgia Al-Shabib, Ali Puleston, Richard Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit |
| title | Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit |
| title_full | Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit |
| title_fullStr | Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit |
| title_full_unstemmed | Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit |
| title_short | Whole genome sequencing in the investigation of recurrent invasive Group A streptococcus outbreaks in a maternity unit |
| title_sort | whole genome sequencing in the investigation of recurrent invasive group a streptococcus outbreaks in a maternity unit |
| topic | iGAS Streptococcus maternity whole genome sequencing |
| url | https://eprints.nottingham.ac.uk/51180/ https://eprints.nottingham.ac.uk/51180/ https://eprints.nottingham.ac.uk/51180/ |