Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-29T16:31:11.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of Healthcare Workers With Pharyngitis or Suspected Streptococcal Infections

Published online by Cambridge University Press:  02 January 2015

David Jay Weber ,
William A. Rutala  and
Floyd W. Denny Jr
David Jay Weber*
Affiliation:
Adult and Pediatric Divisions of Infectious Diseases, University of North Carolina School of Medicine Departments of Hospital Epidemiology and Occupational Health Service, University of North Carolina Hospitals, Chapel Hill, North Carolina
William A. Rutala
Affiliation:
Adult and Pediatric Divisions of Infectious Diseases, University of North Carolina School of Medicine Departments of Hospital Epidemiology and Occupational Health Service, University of North Carolina Hospitals, Chapel Hill, North Carolina
Floyd W. Denny Jr
Affiliation:
Adult and Pediatric Divisions of Infectious Diseases, University of North Carolina School of Medicine
*
Division of Infectious Diseases, CB #7030 Burnett Womack, 547, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030
Get access Rights & Permissions [Opens in a new window]

Abstract

The group A streptococcus may cause pharyngitis, rheumatic fever, streptococcal toxic shock syndrome, and serious skin and soft-tissue infections. More than 50 nosocomial outbreaks have been reported since 1966. For this reason, healthcare facilities should develop policies for the diagnosis and treatment of symptomatic hospital employees, and for the recognition and management of potential outbreaks. The clinical diagnosis of streptococcal pharyngitis is unreliable. Rapid streptococcal tests may be used for initial screening, but a negative rapid test should be confirmed with a properly obtained culture. Penicillin remains the treatment of choice, but new alternatives now include a 5-day course of either azithromycin or cefpodoxime.

Type
Topics in Occupational Medicine
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 11 , November 1996 , pp. 753 - 761
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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. Bisno, AL. Streptococcus pyogenes. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:1786–1799.Google Scholar
2. Denny, FW Jr. Group A streptococcal infections—1993. Curr Probl Pediatr 1993;23:179–185.CrossRefGoogle Scholar
3. Stevens, DL. Invasive group A streptococcus infections. Clin Infect Dis 1992;14:2–13.CrossRefGoogle ScholarPubMed
4. Stevens, DL. Invasive group A streptococcal infections: the past, present and future. Pediatr Infect Dis J 1994;13:561–566.Google ScholarPubMed
5. Spencer, RC. Invasive streptococci. Eur J Clin Microbiol Infect Dis 1995;14(suppl 1):26–32.Google ScholarPubMed
6. Bronze, MS, Dale, JB. The reemergence of serious group A streptococcal infections and acute rheumatic fever. Am J Med Sci 1996;311:41–54.Google Scholar
7. Stevens, DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis 1995;1:69–78.Google Scholar
8. Markowitz, M. Changing epidemiology of group A streptococcal infections. Pediatr Infect Dis J 1994;13:557–560.Google Scholar
9. Dajani, AS. Current status of nonsupporative complications of group A streptococci. Pediatr Infect Dis J 1991;10:25S–27S.Google Scholar
10. Veasy, LG, Tani, LY, Hill, HR. Persistence of acute rheumatic fever in the intermountain area of the United States. J Pediatr 1994;124:9–16.Google Scholar
11. Boyer, KM. Neonatal group B streptococcal infections. Curr Opin Pediatr 1995;7:13–18.Google Scholar
12. Schuchat, A, Wenger, JD. Epidemiology of group B streptococcal disease: risk factors, prevention strategies, and vaccine development. Epidemiol Rev 1994;16:374–402.Google Scholar
13. Farley, MM, Harvey, RC, Stull, T, et al. A population-based assessment of invasive disease due to group B streptococcus in nonpregnant adults. N Engl J Med 1993;328:1807–1811.Google Scholar
14. Wessels, MR, Kasper, DL. The changing spectrum of group B streptococcal disease. N Engl J Med 1993;328:1843–1844.Google Scholar
15. Johnson, CC, Tunkel, AR. Viridans streptococci and groups C and G streptococci. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:1845–1861.Google Scholar
16. Ruoff, KL. Streptococcus. In: Murray, PR, ed. Manual of Clinical Microbiology. 6th ed. Washington, DC: ASM Press; 1995:299–307.Google Scholar
17. Bisno, AL, van de Rijn, I. Classification of streptococci. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:1784–1785.Google Scholar
18. Dajani, A, Taubert, K, Ferrieri, P, et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatrics 1995;96:758–764.CrossRefGoogle ScholarPubMed
19. Denny, FW Jr. Tonsillopharyngitis 1994. Pediatr Rev 1994;15:185–191.Google Scholar
20. Gwaltney, JM. Pharyngitis. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:566–572.Google Scholar
21. Jackson, LA, Hilsdon, R, Farley, MM, et al. Risk factors for group B streptococcal disease in adults. Ann Intern Med 1995;123:415–420.Google Scholar
22. Brook, I. Pharyngotonsillitis. Infectious Disease Practice for the Clinician 1994;18:17–23.Google Scholar
23. Komaroff, AL. Sore throat in adult patients. In: Panzer, RJ, Black, ER, Griner, PF, eds. Diagnostic Strategies for Common Medical Problems. Philadelphia, PA: American College of Physicians; 1991:187–195.Google Scholar
24. Clancy, CM, Centor, RM, Campbell, MS, Dalton, HP. Rational decision making based on history: adult sore throats. J Gen Intern Med 1988;3:213–217.Google Scholar
25. Kline, JA, Runge, JW. Streptococcal pharyngitis: a review of pathophysiology, diagnosis, and management. The Journal of Emergency Medicine 1994;12:665–680.Google Scholar
26. American Academy of Pediatrics. Group A streptococcal infections. In: Peter, G, ed. 1994 Red Book: Report of the Committee on Infectious Diseases. 23rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 1994:430–439.Google Scholar
27. Shulman, ST. Streptococcal pharyngitis: diagnostic considerations. Pediatr Infect Dis J 1994;13:567–571.Google ScholarPubMed
28. Medical Letter. The choice of antibacterial drugs. The Medical Letter 1994;36:53–61.Google Scholar
29. Klein, JO. Management of streptococcal pharyngitis. Pediatr Infect Dis J 1994;13:572–575.Google ScholarPubMed
30. Catanzaro, FJ, Stetson, CA, Morris, AJ, et al. Symposium on rheumatic fever and rheumatic heart disease. Am J Med 1954;17:749–756.Google Scholar
31. Seppala, H, Nissinen, A, Jarvinen, H, et al. Resistance to erythromycin in group A streptococci. N Engl J Med 1992;326:292–297.Google Scholar
32. Pichichero, ME. Group A streptococcal tonsillopharyngitis: cost-effective diagnosis and treatment. Ann Emerg Med 1995;25:390–403.CrossRefGoogle Scholar
33. Rountree, PM. Hospital infection with tetracycline-resistant haemolytic streptococci. Med J Aust 1965;2:446–448.CrossRefGoogle ScholarPubMed
34. McCabe, WR, Abrams, AA. An outbreak of streptococcal puerperal sepsis. N Engl J Med 1965;272:615–618.Google Scholar
35. Nash, FW, Mann, TP, Haydu, IW. An outbreak of streptococcal infection in a maternity unit. Postgrad Med J 1965;41:182–184.CrossRefGoogle Scholar
36. McKee, WM, Di Caprio, JM, Roberts, CE, Sherris, JC. Anal carriage as the probable source of a streptococcal epidemic. Lancet 1966;2:1007–1009.CrossRefGoogle ScholarPubMed
37. Zimmerman, RA, Sciple, GW. Streptococcal wound infections. Rocky Mountain Medical Journal 1966;63:63–65.Google Scholar
38. Mead, PB, Ribble, JC, Dillon, TF. Group A streptococcal puerperal infection. Obstet Gynecol 1968;32:460–464.Google Scholar
39. McIntyre, DM. An epidemic of Streptococcus pyogenes puerperal and postoperative sepsis with an unusual carrier site—the anus. Am J Obstet Gynecol 1968;101:308–314.Google Scholar
40. Schaffner, W, Lefkowitz, LB, Goodman, JS, Koenig, MG. Hospital outbreak of infections with group A streptococci traced to an asymptomatic anal carrier. N Engl J Med 1969;280:1224–1225.Google Scholar
41. Gryska, PF, O'Dea, AE. Postoperative streptococcal wound infection. JAMA 1970;213:1189–1191.Google Scholar
42. Tancer, ML, McManus, JE, Bellotti, G. Group A, type 33, ß-hemolytic streptococcal outbreak on a maternity and newborn service. Am J Obstet Gynecol 1969;103:1028–1033.Google Scholar
43. Geil, CC, Castle, WK, Mortimer, EA. Group A streptococcal infections in newborn nurseries. Pediatrics 1970;46:849–854.Google Scholar
44. Decker, J, Hammond, H, MacArthur, M, Bailey, J, Fukushima, T. Hospital outbreak of streptococcal wound infections—Utah. MMWR 1975;25:141.Google Scholar
45. Nelson, JD, Dillon, HC, Howard, JB. A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus. J Pediatr 1976;89:792–796.CrossRefGoogle ScholarPubMed
46. 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.Google Scholar
47. Stamm, WE, Feeley, JC, Facklam, RR. Wound infection due to group A streptococcus traced to a vaginal carrier. J Infect Dis 1978;138:287–292.Google Scholar
48. Bygdeman, S, Jacobsson, E, Myrback, K-E, Wallmark, G. Hemolytic streptococci among infants in a maternity department. Scand J Infect Dis 1978;10:45–49.CrossRefGoogle Scholar
49. Schrack, WD, Miller, GB, Parkin, WE, Fontana, DB. Four strep- tococcal infections traced to anal carrier. Pennsylvania Medicine 1979;82:35–36.Google Scholar
50. Barnham, M, Kerby, J. Streptococcus pyogenes pneumonia in residential homes: probable spread of infection from the staff. J Hosp Infect 1981;2:255–257.Google Scholar
51. Rahman, M. Outbreak of Streptococcus pyogenes infections in a geriatric hospital and control by mass treatment. J Hosp Infect 1981;2:63–69.CrossRefGoogle Scholar
52. Berkelman, RL, Martin, D, Graham, DR, et al. Streptococcal wound infections caused by a vaginal carrier. JAMA 1982;247:2680–2682.Google Scholar
53. Berg, U, Bygdeman, S, Henningsson, A, Nystrom, B, Tunell, R. An outbreak of group A streptococcal infection in a maternity unit. J Hosp Infect 1982;3:333–339.Google Scholar
54. Reid, RI, Briggs, RS, Seal, DV, Pearson, AD. Virulent Streptococcal pyogenes: outbreak and spread within a geriatric unit. J Infect 1983;6:219–225.Google Scholar
55. Isenberg, HD, Tucci, V, Lipsitz, P, Facklam, RR. Clinical laboratory and epidemiological investigations of a Streptococcus pyo-genes cluster epidemic in a newborn nursery. J Clin Microbiol 1984;19:366–370.CrossRefGoogle Scholar
56. Ruben, FL, Norden, CW, Heisler, B, Korica, Y. An outbreak of Streptococcus pyogenes infections in a nursing home. Ann Intern Med 1984;101:494–496.Google Scholar
57. Wiesenthal, AM. A maternal-neonatal outbreak of infections due to an unusual group A β-hemolytic streptococcus. Infect Control 1984;5:271–274.CrossRefGoogle Scholar
58. Whitby, M, Sleigh, JD, Reid, W, McGregor, I, Colman, G. Streptococcal infection in regional burns centre and a plastic surgery unit. J Hosp Infect 1984;5:63–69.Google Scholar
59. Decker, MD, Lavely, GB, Hutcheson, RH, Schaffner, W. Food-borne streptococcal pharyngitis in a hospital pediatrics clinic. JAMA 1985;253:679–681.Google Scholar
60. Claesson, BEB, Claesson, UL-E. An outbreak of endometritis in a maternity unit caused by spread of group A streptococci from a showerhead. J Hosp Infect 1985;6:304–311.Google Scholar
61. Lannigan, R, Hussain, Z, Austin, TW. Streptococcus pyogenes as a cause of nosocomial infection in a critical care unit. Diagn Microbiol Infect Dis 1985;3:337–341.Google Scholar
62. Stetler, HC, Garbe, PL, Dwyer, DM, et al. Outbreaks of group A streptococcal abscesses following diphtheria-tetanus toxoid-pertussis vaccination. Pediatrics 1985;75:299–303.CrossRefGoogle Scholar
63. Nicolle, LE, Hume, K, Sims, H, Rosenal, T, Sandham, D. An outbreak of streptococcal bacteremia in an intensive care unit. Infect Control 1986;7:177–180.Google Scholar
64. Lehtonen, O-PJ, Kero, P, Ruuskanen, O, et al. A nursery outbreak of group A streptococcal infection. J Hosp Infect 1987;14:263–270.Google Scholar
65. Webster, A, Scott, GMS, Ridgway, GL, Gruneberg, RN. An outbreak of group A streptococcal skin infection: control by source isolation and teicoplanin therapy. Scand J Infect Dis 1987;19:205–209.Google Scholar
66. Hansen, JL, Paulissen, JP, Larson, AL, et al. Nursing home outbreaks of invasive group A streptococcal infections—Illinois, Kansas, North Carolina, and Texas. MMWR 1990;39:577–579.Google Scholar
67. 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.Google Scholar
68. Burnett, IA, Norman, P. Streptococcus pyogenes: an outbreak on a burns unit. J Hosp Infect 1990;15:173–176.Google Scholar
69. Allen, KD, Ridgway, EJ. Streptococcus pyogenes: an outbreak on a burns unit. J Hosp Infect 1990;16:178–179.Google Scholar
70. Paul, SM, Genese, C, Spitalny, K. Postoperative group A ß-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
71. Harkness, GA, Bentley, DW, Mottley, M, Lee, J. Streptococcus pyo-genes outbreak in a long-term care facility. Am J Infect Control 1992;20:142–148.Google Scholar
72. Auerbach, SB, Schwartz, B, Williams, D, et al. Outbreak of invasive group A streptococcal infections in a nursing home. Arch Intern Med 1992;152:1017–1022.Google Scholar
73. Schwartz, B, Ussery, XT. Group A streptococcal outbreaks in nursing homes. Infect Control Hosp Epidemiol 1992;13:742–747.Google Scholar
74. Ridgway, EJ, Allen, KD. Clustering of Group A streptococcal infections on a burns unit: important lessons in outbreak management. J Hosp Infect 1993;25:173–182.Google Scholar
75. Simon, PA, Chen, RT, Elliott, JA, Schwartz, B. Outbreak of pyogenic abscesses after diphtheria and tetanus toxoids and pertussis vaccination. Pediatr Infect Dis J 1993;12:368–371.Google Scholar
76. Gordon, G, Dale, BAS, Lockhead, D. An outbreak of group A haemolytic streptococcal puerperal sepsis spread by the communal use of bidets. Br J Obstet Gynaecol 1994;101:447–448.Google Scholar
77. Sarangi, J, Rowsell, R. A nursing home outbreak of group A streptococcal infection: case control study of environmental contamination. J Hosp Infect 1995;30:162–164.Google Scholar
78. Quinn, RW, Hillman, JW. An epidemic of streptococcal wound infections. Arch Environ Health 1965;11:28–33.Google Scholar
79. Dillon, HC. Group A type 12 streptococcal infection in a newborn nursery. Am J Dis Child 1966;112:177–184.Google Scholar
80. Jewett, JF, Reid, DE, Sajon, LE, Easterday, CL. Childbed fever—a continuing entity. JAMA 1968;206:344–350.CrossRefGoogle ScholarPubMed
81. Cayton, HR, Morris, CA. Injection site streptococcal abscesses in a clinic using disposable syringes. Monthly Bulletin of the Ministry of Health & the Public Health Laboratory Service 1966;25:87–91.Google Scholar
82. Gezon, HM, Schaberg, MJ, Klein, JO. Concurrent epidemics of Staphylococcus aureus and group A streptococcus disease in a newborn nursery—control with penicillin G and hexa- chlorophene bathing. Pediatrics 1973;51:383–390.CrossRefGoogle Scholar
83. Peter, G, Hazard, J. Neonatal group A streptococcal disease. J Pediatr 1975;87:454–455.Google Scholar
84. Dowsett, EG, Herson, RN, Maxted, WR, Widdowson, JP. Outbreak of idiopathic er ysipelas in a psychiatric hospital. Br Med J 1975;1:500–502.Google Scholar
85. Greaves, WL, Hinman, AR, Facklam, RR, Allman, KC, Barrett, CL, Stetler, HC. Streptococcal abscesses following diphtheria-tetanus toxoid-pertussis vaccination. Pediatr Infect Dis 1982;1:388–390.Google Scholar
86. McGregor, J, Ott, A, Villard, M. An epidemic of ‘childbed fever’. Am J Obstet Gynecol 1984;150:385–388.Google Scholar
87. Pritchard, VG, Kerry, CS. Streptococcal outbreak. J Gerontol Nurs 1988;14:19–23.Google Scholar
88. Schwartz, B, Elliott, JA, Butler, JC, et al. Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings. Clin Infect Dis 1992;15:277–284.Google Scholar
89. Church, DL, Bryant, HE. Investigation of a Streptococcus viri-dans pseudobacteremia epidemic at a university teaching hospital. Infect Control Hosp Epidemiol 1989;10:416–421.Google Scholar
90. Teare, EL, Smithson, RD, Efstratiou, A, Devenish, WR, Noah, ND. An outbreak of puerperal fever caused by group C streptococci. J Hosp Infect 1989;13:337–347.Google Scholar
91. Galloway, A, Noel, I, Efstratiou, A, Saint, E, White, DR. An outbreak of group C streptococcal infection in a maternity unit. J Hosp Infect 1994;28:31–37.Google Scholar
92. Haynes, J, Anderson, AW, Spence, WN. An outbreak of puerperal fever caused by group G streptococci. J Hosp Infect 1987;9:120–125.Google Scholar
93. DeNeef, P. Role of rapid tests for streptococcal pharyngitis in hospital infection control. Am J Infect Control 1987;15:20–25.Google Scholar
94. Watanakunakorn, C. Should routine throat cultures be done in hospital personnel complaining of a sore throat. Infect Control 1985;6:183–185.Google Scholar
95. Williams, WW. Guideline for infection control in hospital personnel. Infect Control 1983;4:326–348.Google Scholar