Management of Contacts of Patients With Severe Invasive Group A Streptococcal Infection

• Published in: Journal of the Pediatric Infectious Diseases Society 2016-03, Vol.5 (1), p.47-52
• Main Authors: Torres, Rosângela Stadnick Lauth de Almeida, Santos, Talita Zajac dos, Torres, Robson Antônio de Almeida, Petrini, Lygia Maria Coimbra de Manuel, Burger, Marion, Steer, Andrew C., Smeesters, Pierre R.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Antigens, Bacterial - genetics; Bacterial Outer Membrane Proteins - genetics; Bacterial Typing Techniques; Carrier Proteins - genetics; Child; Child, Preschool; Community-Acquired Infections - drug therapy; Community-Acquired Infections - pathology; Community-Acquired Infections - prevention & control; Community-Acquired Infections - transmission; Fasciitis, Necrotizing - microbiology; Fatal Outcome; Female; Humans; Male; Microbial Sensitivity Tests; Patient Education as Topic; Pharynx - microbiology; Streptococcal Infections - drug therapy; Streptococcal Infections - pathology; Streptococcal Infections - prevention & control; Streptococcal Infections - transmission; Streptococcus pyogenes - classification; Streptococcus pyogenes - drug effects; Streptococcus pyogenes - isolation & purification; Streptococcus pyogenes - pathogenicity; Virulence; Virulence Factors - genetics
• ISSN: 2048-7193; 2048-7207
• DOI: 10.1093/jpids/piu107

Background Conflicting recommendations regarding antibiotic prophylaxis for contacts of patients with invasive group A streptococcal (GAS) infection exist. Close contacts of patients with such severe and rapidly progressive disease often strongly appeal to the treating clinicians for antimicrobial treatment to prevent additional cases. We aimed to use an approach based on pharyngeal culture testing of contacts and targeted antibiotic prophylaxis. Methods A large throat swab survey including 105 contacts was undertaken after a fulminant and fatal case of GAS necrotizing fasciitis. GAS strains were characterized by emm typing and antimicrobial susceptibility to 7 antibiotics. The presence of 30 virulence determinants was determined by polymerase chain reaction and sequencing. Results The GAS isolate recovered from the index patient was an M1T1 GAS clone susceptible to all antimicrobial agents tested. The same clone was present in the throat of 36% of close contacts who had exposure to the index patient (family households and classroom contacts) for >24 hours/week, whereas the strain was present in only 2% of the other contacts. Conclusions Although the study does not allow firm conclusions to be drawn as to whether antibiotic prophylaxis is effective, we describe a practical approach, including an educational campaign and targeted antibiotic treatment to close contacts who have been exposed to an index patient for > 24 hours/week before the initial disease onset.