A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire

Abstract

SummaryWe describe the first cluster of cases of necrotizing fasciitis (NF) in this century in the United Kingdom (UK). Between 1 January and 30 June 1994 there were six cases (five confirmed, one probable) ofStreptococcus pyogenesNF in west Gloucestershire, population 320000. Two cases died. The first two patients probably acquired their infections during the course of elective surgery performed in the same operating theatre, possibly from a nasopharyngeal carrier amongst the theatre staff. The remaining infections were community-acquired. Of 5S. pyogenesisolates there were 2 M1 strains, 1 M3, 1 M5 and 1 M non-typeable strain.S. pyogenesNF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence ofS. pyogenesbacteraemia in England and Wales had not risen in the past 5 years.The two presumably theatre-acquired infections raised several issues. The need for detailed bacteriological investigation of all cases of post-surgical NF was confirmed. Clusters ofS. pyogenesinfection following surgery should be managed by closure of the operating theatre until all staff have been screened for carriage. Closure of an operating theatre and screening of staff following a sporadic case is probably not justified because of the infrequency of surgical cross-infection withS. pyogenes. Regular, routine screening of theatre staff is neither practical nor necessary.