GROUP A STREPTOCOCCAL INFECTIONS IN NEWBORN NURSERIES

Abstract

Two outbreaks of group A streptococcal colonization of newborn infants over a 3-year period were observed. Manifestations of the outbreak included indolent oomphalitis in most infants, but two babies developed sepsis. Transmission to family members occurred after discharge in several instances. The offending strains were untypable by M protein precipitin techniques, but by T-agglutination techniques were identified as T28 in the first outbreak and T11/9 in the second out-break.

The origin of the first outbreak appeared to be an infant who acquired the strain from his mother's vaginal tract during delivery, but the origin of the second episode could not be identified. Perpetuation of the outbreaks appeared to be mediated by infant-to-infant transmission with the umbilical stump being the primary site of colonization.

Control of the first outbreak was not achieved until all infants with positive cultures were treated with penicillin and all exposed infants received prophylactic penicillin until a complete turnover of the nursery population occurred. This regimenfailed to eradicate the second outbreak, which was finally controlled by treating all affected infants with penicillin and applying bacitracin ointment to the umbilical stumps of all other infants for 15 days. It is possible that the difficulty in interrupting the second outbreak resulted from failure to identify a continuing carrier among personnel.