Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T20:06:36.616Z Has data issue: false hasContentIssue false
  • English
  • Français

Molecular Characterization of Streptococcus Pyogenes Isolates to investigate an outbreak of Puerperal Sepsis

Published online by Cambridge University Press:  21 June 2016

Josette Raymond ,
Laurent Schlegel ,
Fabien Garnier  and
Anne Bouvet
Josette Raymond
Affiliation:
Microbiology Department, Hòpital Saint Vincent de Paul, Paris V University, Paris, France
Laurent Schlegel
Affiliation:
National Reference Center for Streptococci, Hòtel Dieu AP-HP, Paris V University, Paris, France
Fabien Garnier
Affiliation:
Microbiology Department, Hòpital Saint Vincent de Paul, Paris V University, Paris, France
Anne Bouvet*
Affiliation:
National Reference Center for Streptococci, Hòtel Dieu AP-HP, Paris V University, Paris, France
*
Centre National de Réference des Streptocoques, Service de Microbiologie, Hòtel Dieu, Université Paris V, 1 place du Parvis Notre-Dame, F 75181 Paris 04, France[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe microbiological characteristics and epidemiologic features of an outbreak of postpartum endometritis.

Methods:

Various markers were investigated in five patients and three throat carriage isolates of Streptococcus pyogenes obtained during an outbreak of endometritis occurring in a 13-week period. Molecular characterization included biotyping, T-serotyping, emm gene sequence and restriction, pulsed-field gel electrophoresis (PFGE), and random amplified polymorphic DNA (RAPD) analysis.

Results:

Biotype, T-serotype, and genotypic data (emm analysis, PFGE, and RAPD analysis) revealed a close relationship among the isolates from three patients, suggesting that cross-contamination had occurred. These isolates were biotype 1, T type 28, and emm type 28. The isolates from one patient and one carrier differed from those of the index patient by minor variations of the emm amplicon restriction pattern, PFGE pattern, or RAPD pattern. The remaining isolates were phenotypically and genetically different.

Conclusion:

Identification of different isolates demonstrated that different strains may circulate simultaneously during a true outbreak and that the predominant strain might persist for several months.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 5 , May 2005 , pp. 455 - 461
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Holmes, OW. The contagiousness of puerperal fever. The New England Quarterly Journal of Medicine and Surgery 1843;1:503–530.Google Scholar
2.Semmelweis, IP. Die Aetiology, der Begriffund die Prophylaxis des Kind-bettfiebers. Leipzig, Germany: C.A. Hartleben; 1861.Google Scholar
3.Pasteur, L. Septicemic puerperale. Bull Acad Natl Med 1879;8:271–274.Google Scholar
4.Gordon, G, Dale, BAS, Lochhead, D. An outbreak of group Ahaemolytic streptococcal puerperal sepsis spread by the communal use of bidets. Br J Obstet Gynaecol 1994;101:447–448.CrossRefGoogle Scholar
5.Jorup-Ronstrbm, C, Hofling, M, Lundberg, C, Holm, S. Streptococcal toxic shock syndrome in a postpartum woman: case report and review of the literature. Infection 1996;24:164–167.CrossRefGoogle Scholar
6.Strobcek, S, Zimakoff, J, Kristensen, KF, Borgen, H, Serensen, L. Puerperal fever: a survey of an epidemic using a case-controlled study [in Danish]. Ugeskr Laeger 1997;159:4117–4122.Google Scholar
7.Carapetis, J, Robins-Browne, R, Martin, D, Shelby-James, T, Hogg, G. Increasing severity of invasive group A streptococcal disease in Australia: clinical and molecular epidemiological features and identification of a new virulent M-nontypeable clone. Clin Infect Dis 1995;21:1220–1227.CrossRefGoogle Scholar
8.Davies, HD, McGeer, A, Schwartz, B, et al. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med 1996;335:547–554.CrossRefGoogle ScholarPubMed
9.Hoge, CW, Schwartz, B, Talkington, DF, Breiman, RF, MacNeill, EM, Englender, SJ. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome: a retrospective population-based study. JAMA 1993;269:384–389.CrossRefGoogle ScholarPubMed
10.Johnson, DR, Stevens, DL, Kaplan, EL. Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis. J Infect Dis 1992;166:374–382.CrossRefGoogle ScholarPubMed
11.Martin, PR, Heiby, EA. Streptococcal serogroup A epidemic in Norway 1987-88. Scand J Infect Dis 1990;22:421–429.CrossRefGoogle Scholar
12.Moses, AE, Goldberg, S, Korenman, Z, et al. Invasive group A streptococcal infections, Israel. Emerg Infect Dis 2002;8:421–426.CrossRefGoogle ScholarPubMed
13.Stevens, DL. Invasive group A Streptococcus infections. Clin Infect Dis 1992;14:2–13.CrossRefGoogle ScholarPubMed
14.Stromberg, A, Romanus, V, Burman, LG. Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study. J Infect Dis 1991;164:595–598.CrossRefGoogle Scholar
15.Varon, E, Havlickova, H, Gires, A, et al. Group A streptococcal infections in France: clinical features and epidemiological markers. Adv Exp Med Biol 1997;418:229–231.CrossRefGoogle ScholarPubMed
16.Chuang, I, van Beneden, C, Beall, B, Schuchat, A, Active Bacterial Core Surveillance/Emerging Infections Program Network. Population-based surveillance for postpartum invasive group A streptococcus infections, 1995-2000. Clin Infect Dis 2002;35:665–670.CrossRefGoogle Scholar
17.Bosch, T, Riera, M, Galmes, M, Ramirez, A, Alberti, S. Infecciones inva-soras por estreptococos del grupo A: caracteristicas clinicas y analisis microbiologico de 31 casos. Enferm Infecc Microbiol Clin 2001;19:371–375.CrossRefGoogle Scholar
18.Efstratiou, A. Group A streptococci in the 1990s. J Antimicrob Chemother 2000;45:3–12.CrossRefGoogle Scholar
19.Muller-Alouf, H, Geoffroy, C, Geslin, P, et al. Serotype, biotype, pyro-genic exotoxin, streptolysin O and exoenzyme patterns of invasive Streptococcus pyogenes isolates from patients with toxin shock syndrome, bacteremia and other severe infections. Adv Exp Med Biol 1997;418:241–243.CrossRefGoogle ScholarPubMed
20.Varon, E, Havlickova, H, Pitman, C, et al. Comparison of invasive (septicemic) strains of group A streptococci isolated during a one-year national survey in France. Adv Exp Med Biol 1997;418:83–85.CrossRefGoogle Scholar
21.Schmitz, FJ, Beyer, A, Charpentier, E, et al. Toxin-gene profile heterogeneity among endemic invasive European group A streptococcal isolates. J Infect Dis 2003;188:1578–1586.CrossRefGoogle Scholar
22.Centers for Disease Control and Prevention. Hospital outbreak of streptococcal wound infection, Utah. MMWR 1976;25:141.Google Scholar
23.Kolmos, HJ, Svendsen, RN, Nielsen, SV. The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes. J Hosp Infect 1997;35:207–214.CrossRefGoogle ScholarPubMed
24.Mastro, TD, Farley, TA, Elliott, JA, et al. An outbreak of surgical-wound infections due to group A Streptococcus carried on the scalp. N Engl J Med 1990;323:968–972.CrossRefGoogle ScholarPubMed
25.McIntyre, DM. An epidemic of Streptococcus pyogenes puerperal and postoperative sepsis with an unusual carrier site: the anus. Am J Obstet Gynecol 1968;101:308–313.CrossRefGoogle ScholarPubMed
26.Paul, SM, Genese, C, Spitalny, K. Postoperative group A β-hemolytic Streptococcus outbreak with the pathogen traced to a member of a healthcare worker's household. Infect Control Hosp Epidemiol 1990;11:643–646.CrossRefGoogle Scholar
27.Richman, DD, Breton, SJ, Goldmann, DA. Scarlet fever and group A streptococcal surgical wound infection traced to an anal carrier. J Pediatr 1977;90:387–390.CrossRefGoogle Scholar
28.Saxen, H, Muotiala, A, Rostila, T, Vuopio-Varkila, J. Outbreak of perianal Streptococcus pyogenes infection in a day-care center. Pediatr Infect Dis J 1997;16:247–248.CrossRefGoogle Scholar
29.Viglionese, A, Nottebart, VF, Bodman, HA, Piatt, R. Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks. Am J Med 1991;91:329S–333S.CrossRefGoogle Scholar
30.Gallo, G, Berzero, R, Cattai, N, Recchia, S, Orefici, G. An outbreak of group A food-borne streptococcal pharyngitis. Eur J Epidemiol 1992;8:292–297.CrossRefGoogle Scholar
31.Johnson, DR, Kaplan, EL. A review of the correlation of T-agglutination patterns and M-protein typing and opacity factor production in the identification of group A streptococci. J Med Microbiol 1993;38:311–315.CrossRefGoogle ScholarPubMed
32.Lancefield, RC. The antigenic complex of Streptococcus haemolyticus: I. Demonstration of a type-specific substance in extracts of Streptococcus haemolyticus. J Exp Med 1928;47:91–103.CrossRefGoogle ScholarPubMed
33.Maxted, WR, Widdowson, JP, Fraser, CA., Ball, LC, Bassett, DCJ. The use the serum opacity reaction in the typing of group-A streptococci. J Med Microbiol 1973;6:83–90.CrossRefGoogle ScholarPubMed
34.Beall, B, Facklam, RR, Elliott, JA, et al. Streptococcal emm types associated with T-agglutination types and the use of conserved emm gene restriction fragment patterns for subtyping group A streptococci. J Med Microbiol 1998;47:893–898.CrossRefGoogle ScholarPubMed
35.Beall, B, Facklam, R, Thompson, T. Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci. J Clin Microbiol 1996;34:953–958.CrossRefGoogle ScholarPubMed
36.Facklam, R, Beall, B, Efstratiou, A, et al. emm typing and validation of provisional M types for group A streptococci. Emerg Infect Dis 1999;5:247–253.CrossRefGoogle ScholarPubMed
37.Bert, F, Branger, C, Lambert-Zechovsky, N. Pulsed-field gel electrophoresis is more discriminating than multilocus enzyme electrophoresis and random amplified polymorphic DNA analysis for typing pyogenic streptococci. Curr Microbiol 1997;34:226–229.CrossRefGoogle ScholarPubMed
38.Chatellier, S, Ihendyane, N, Kansal, RG, et al. Genetic relatedness and superantigen expression in group A Streptococcus serotype M1 isolates from patients with severe and nonsevere invasive diseases. Infect Immun 2000;68:3523–3534.CrossRefGoogle ScholarPubMed
39.Gruteke, P, van Belkum, A, Schouls, LM, et al. Outbreak of group A streptococci in a burn center: use of pheno- and genotypic procedures for strain tracking. J Clin Microbiol 1996;34:114–118.CrossRefGoogle Scholar
40.Seppälä, H, He, Q, Osterblad, M, Huovinen, P. Typing of group A streptococci by random amplified polymorphic DNA analysis. J Clin Microbiol 1994;32:1945–1948.CrossRefGoogle Scholar
41.Shundi, L, Surdeanu, M, Damian, M. Comparison of serotyping, ribo-typing and pulsed-field gel electrophoresis for distinguishing group A Streptococcus strains isolated in Albania. Eur J Epidemiol 2000;16:257–263.CrossRefGoogle Scholar
42.Tyler, SD, Johnson, WM, Huang, JC, et al. Streptococcal erythrogenic toxin genes: detection by polymerase chain reaction and association with disease in strains isolated in Canada from 1940 to 1991. J Clin Microbiol 1992;30:3127–3131.CrossRefGoogle ScholarPubMed
43.Bouvet, A, Geslin, P, Kriz-Kuzemenska, P, Blanc, V, Devine, C, Grimont, F. Restricted association between biotypes and serotypes within group A streptococci. J Clin Microbiol 1994;32:1312–1317.CrossRefGoogle ScholarPubMed
44.Johnson, DR, Kaplan, EL, Sramek, J, et al. Determination of T-protein agglutination patterns. In: Laboratory Diagnosis of Group A Streptococcal Infections. Geneva: World Health Organization; 1996:37–41.Google Scholar
45.Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases. Protocol for emm Typing. Atlanta, GA: Centers for Disease Control and Prevention; 2005. Available at www.cdc.gov/ncidod/biotech/strep/protocols.htm.Google Scholar
46.Williams, JGK, Kubelik, AR, Livak, KJ, Rafalski, JA, Tingey, SV. DNA polymorphisms amplified by arbitrary primers are useful as genetic markers. Nucleic Acids Res 1990;18:6531–6535.CrossRefGoogle ScholarPubMed
47.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
48.Yu, CE, Ferretti, JJ. Frequency of the erythrogenic toxin B and C genes (speB and speC) among clinical isolates of group A streptococci. Infect Immun 1991;59:211–215.CrossRefGoogle Scholar
49.Kaplan, EL, Johnson, DR, Rehder, CD. Recent changes in group A streptococcal serotypes from uncomplicated pharyngitis: a reflection of the changing epidemiology of severe group A infections? J Infect Dis 1994;170:1346–1347.CrossRefGoogle Scholar
50.Andersen, MM, Rønne, T. Group A streptococcal bacteraemias in Denmark 1987-89. J Infect 1995;31:33–37.CrossRefGoogle Scholar
51.Beall, B, Facklam, R, Hoenes, T, Schwartz, B. Survey of emm gene sequences and T-antigen types from systemic Streptococcus pyogenes infection isolates collected in San Francisco, California; Atlanta, Georgia; and Connecticut in 1994 and 1995. J Clin Microbiol 1997;35:1231–1235.CrossRefGoogle Scholar
52.O'Brien, KL, Beall, B, Barett, NL, et al. Epidemiology of invasive group A Streptococcus disease in the United States, 1995-1999. Clin Infect Dis 2002;35:268–276.CrossRefGoogle ScholarPubMed
53.Barnham, MRD, Weightman, NC. Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important. J Infect 2001;43:173–176.CrossRefGoogle ScholarPubMed
54.Mihaila-Amrouche, L, Bouvet, A, Loubinoux, J. Clonal spread of emm type 28 isolates of Streptococcus pyogenes multiresistant to antibiotics. J Clin Microbiol 2004;42:3844–3846.CrossRefGoogle ScholarPubMed
55.McGregor, J, Ott, A, Villard, M. An epidemic of “childbed fever.” Am J Obstet Gynecol 1984;150:385–388.CrossRefGoogle ScholarPubMed
56.Centers for Disease Control and Prevention. Nosocomial group A streptococcal infections associated with asymptomatic healthcare workers: Maryland and California, 1997. MMWR 1999;48:163–166.Google Scholar
57.Musser, JM, Hauser, AR, Kim, MH, Schlievert, PM, Nelson, K, Selander, RK. Streptococcus pyogenes causing toxic-shock-like syndrome and other invasive diseases: clonal diversity and pyrogenic exotoxin expression. Proc Natl Acad Sci USA. 1991;88:2668–2672.CrossRefGoogle ScholarPubMed
58.Stanley, J, Desai, M, Xerry, J, Tanna, A, Efstratiou, A, George, R. High-resolution genotyping elucidates the epidemiology of group A Streptococcus outbreaks. J Infect Dis 1996;174:500–506.CrossRefGoogle Scholar
59.Single, LA, Martin, DR. Clonal differences within M-types of the group A Streptococcus revealed by pulsed field gel electrophoresis. FEMS Microbiol Lett 1992;91:85–90.CrossRefGoogle Scholar
60.Stanley, J, Linton, D, Desai, M, Efstratiou, A, George, R. Molecular subtyping of prevalent M serotypes of Streptococcus pyogenes causing invasive disease. J Clin Microbiol 1995;33:2850–2855.CrossRefGoogle ScholarPubMed
61.Muotiala, A, Seppälä, H, Huovinen, P, Vuopio-Varkila, J. Molecular comparison of group A streptococci of T1M1 serotype from invasive and noninvasive infections in Finland. J Infect Dis 1997;175:392–399.CrossRefGoogle Scholar
62.Desai, M, Efstratiou, A, George, R, et al. High-resolution genotyping of Streptococcus pyogenes serotype M1 isolates by fluorescent amplified-fragment length polymorphism analysis. J Clin Microbiol 1999;37:1948–1952.CrossRefGoogle ScholarPubMed
63.Seppälä, H, Vuopio-Varkila, J, Österblad, M, et al. Evaluation of methods for epidemiologic typing of group A streptococci. J Infect Dis 1994;169:519–525.CrossRefGoogle ScholarPubMed
64.Quinn, RW, Hillman, JW. An epidemic of streptococcal wound infections. Arch Environ Health 1965;11:28–33.CrossRefGoogle ScholarPubMed
65.Rutishauer, J, Funke, G, Lutticken, R, Ruef, C. Streptococcal toxic shock syndrome in two patients infected by a colonized surgeon. Infection 1999;27:259–260.CrossRefGoogle Scholar
66.Ejlertsen, T, Prag, J, Pettersson, E, Holmskov. A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis. Scand J Infect Dis 2001;33:734–737.CrossRefGoogle ScholarPubMed
67.The Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950–959.CrossRefGoogle Scholar