{"indexed":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T21:15:42Z","timestamp":1509138942347},"reference-count":39,"publisher":"Cambridge University Press (CUP)","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec id=\"S0899823X15003062_abs1\" sec-type=\"general\"><jats:title>OBJECTIVE<\/jats:title><jats:p>To describe an outbreak of severe Group A<jats:italic>Streptococcus<\/jats:italic>(GAS) infections that appeared to be associated with use of a biologic dermal substitute on foot wounds<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15003062_abs2\" sec-type=\"general\"><jats:title>DESIGN<\/jats:title><jats:p>Retrospective cohort study of cases and similar uninfected patients<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15003062_abs3\" sec-type=\"general\"><jats:title>SETTING\/PATIENTS<\/jats:title><jats:p>Patients attending the podiatry clinic at a Veterans Affairs Medical Center between July 2011 and November 2011<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15003062_abs4\" sec-type=\"general\"><jats:title>INTERVENTIONS<\/jats:title><jats:p>Microbiology laboratory data were reviewed for the calendar year, a case definition was established and use of the biologic dermal substitute was discontinued. Staff were cultured to identify potentially colonized employees. A case\u2013cohort study was designed to investigate risk factors for disease.<jats:italic>Emm<\/jats:italic>typing and pulsed field gel electrophoresis (PFGE) were performed to identify strain similarity.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15003062_abs5\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>In 10 months, 14 cases were identified, and 4 of these patients died. All strains were<jats:italic>emm<\/jats:italic>type 28 and were identical according to PFGE. Discontinuation of biologic dermal substitute use halted the outbreak. A prior stroke was more common in the case cohort vs uninfected patient cohorts. The number of patients attending the clinic on 13 probable transmission days was significantly higher than on nontransmission days. We identified 2 patients who were present in the clinic on all but 1 probable transmission day. Surveillance cultures of podiatry clinic staff and cultures of the same lot of retained graft material were negative.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15003062_abs6\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p>A carrier was not identified, and we believe the outbreak was associated with inter-patient transmission likely due to lapses in infection control techniques. No additional cases have been identified in &amp;gt;3 years following the resumption of dermal substitute use in May 2012.<\/jats:p><jats:p><jats:italic>Infect. Control Hosp. Epidemiol.<\/jats:italic>2016;37(3):306\u2013312<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2015.306","type":"article-journal","created":{"date-parts":[[2015,12,17]],"date-time":"2015-12-17T00:00:47Z","timestamp":1450310447000},"page":"306-312","source":"Crossref","is-referenced-by-count":0,"title":"An Outbreak of Severe Group A Streptococcus Infections Associated with Podiatric Application of a Biologic Dermal Substitute","prefix":"10.1017","volume":"37","author":[{"given":"Lauren A.","family":"Ibrahim","affiliation":[]},{"given":"John A.","family":"Sellick","affiliation":[]},{"given":"Elaine L.","family":"Watson","affiliation":[]},{"given":"Lisa M.","family":"McCabe","affiliation":[]},{"given":"Karen A.","family":"Schoenhals","affiliation":[]},{"given":"Richard A.","family":"Martinello","affiliation":[]},{"given":"Alan 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