Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis
Abstract Background In a Dutch tertiary care hospital, two cases of puerperal sepsis were diagnosed within 16 days in June-July 2022. The subsequent outbreak investigation emphasizes the value of collaboration between hospital infection control, regional public health services (PHS) and a national r...
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BMC
2025-05-01
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| Series: | Antimicrobial Resistance and Infection Control |
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| Online Access: | https://doi.org/10.1186/s13756-025-01564-z |
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| author | Irene V. Hoogendijk Diane de Zwart - Slats Stefan A. Boers Boas C.L. van der Putten Nina M. van Sorge Bibi D.H. Molenaar Myrthe M.A. Toorop Marieke B. Veenhof Karin Ellen Veldkamp Adriënne S. van der Schoor Joffrey van Prehn |
| author_facet | Irene V. Hoogendijk Diane de Zwart - Slats Stefan A. Boers Boas C.L. van der Putten Nina M. van Sorge Bibi D.H. Molenaar Myrthe M.A. Toorop Marieke B. Veenhof Karin Ellen Veldkamp Adriënne S. van der Schoor Joffrey van Prehn |
| author_sort | Irene V. Hoogendijk |
| collection | DOAJ |
| description | Abstract Background In a Dutch tertiary care hospital, two cases of puerperal sepsis were diagnosed within 16 days in June-July 2022. The subsequent outbreak investigation emphasizes the value of collaboration between hospital infection control, regional public health services (PHS) and a national reference laboratory. The aim was to identify possible causes of this increase to prevent further cases of puerperal sepsis. Methods Hospital infection control identified a group of puerperal sepsis cases clustered within the last year in the hospital, a cluster caused by S. pyogenes emm12.0. The hospital and PHS performed contact tracing of cases and HCW involved, investigating epidemiological links, and screening of HCW. The Netherlands Reference Laboratory for Bacterial Meningitis (NRLBM) identified additional regional cases. Subsequently, whole genome sequencing (WGS) analysis was performed on clinical, HCW and regional S. pyogenes isolates. Results Four maternity ward patients were diagnosed with puerperal sepsis caused by S. pyogenes emm12.0 between April and November 2022. Although no additional epidemiological links were identified, all four cases resided within a 6.6 km radius. WGS analysis showed that the four cases were part of an 11-case cluster. Screening of HCW (n = 197) identified two individuals carrying clonally related S. pyogenes isolates. Conclusions Collaboration between hospital, PHS, and NRLBM resulted in an overview of possible epidemiological links. Centralized collection of iGAS case information and strain typing are critical to place hospital clusters in the context of local epidemiology. An increase in healthcare-associated infections may not necessarily imply in-hospital transmission. |
| format | Article |
| id | doaj-art-1d9da737912f4b99a6f313016efd5ac0 |
| institution | DOAJ |
| issn | 2047-2994 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj-art-1d9da737912f4b99a6f313016efd5ac02025-08-20T03:16:31ZengBMCAntimicrobial Resistance and Infection Control2047-29942025-05-011411710.1186/s13756-025-01564-zValue of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsisIrene V. Hoogendijk0Diane de Zwart - Slats1Stefan A. Boers2Boas C.L. van der Putten3Nina M. van Sorge4Bibi D.H. Molenaar5Myrthe M.A. Toorop6Marieke B. Veenhof7Karin Ellen Veldkamp8Adriënne S. van der Schoor9Joffrey van Prehn10Department of Medical Microbiology and Infection Prevention, Centre for Infectious Diseases (LU-CID), Leiden University, Leiden University Medical CentreDepartment of infectious disease, Public Health Service region Hollands MiddenDepartment of Medical Microbiology and Infection Prevention, Centre for Infectious Diseases (LU-CID), Leiden University, Leiden University Medical CentreDepartment of Medical Microbiology and Infection Prevention, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical CentreDepartment of Medical Microbiology and Infection Prevention, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical CentreDepartment of Occupational Medicine, Leiden University Medical CentreDepartment of Medical Microbiology and Infection Prevention, Centre for Infectious Diseases (LU-CID), Leiden University, Leiden University Medical CentreDepartment of Obstetrics, Leiden University Medical CentreDepartment of Medical Microbiology and Infection Prevention, Centre for Infectious Diseases (LU-CID), Leiden University, Leiden University Medical CentreDepartment of infectious disease, Public Health Service region Hollands MiddenDepartment of Medical Microbiology and Infection Prevention, Centre for Infectious Diseases (LU-CID), Leiden University, Leiden University Medical CentreAbstract Background In a Dutch tertiary care hospital, two cases of puerperal sepsis were diagnosed within 16 days in June-July 2022. The subsequent outbreak investigation emphasizes the value of collaboration between hospital infection control, regional public health services (PHS) and a national reference laboratory. The aim was to identify possible causes of this increase to prevent further cases of puerperal sepsis. Methods Hospital infection control identified a group of puerperal sepsis cases clustered within the last year in the hospital, a cluster caused by S. pyogenes emm12.0. The hospital and PHS performed contact tracing of cases and HCW involved, investigating epidemiological links, and screening of HCW. The Netherlands Reference Laboratory for Bacterial Meningitis (NRLBM) identified additional regional cases. Subsequently, whole genome sequencing (WGS) analysis was performed on clinical, HCW and regional S. pyogenes isolates. Results Four maternity ward patients were diagnosed with puerperal sepsis caused by S. pyogenes emm12.0 between April and November 2022. Although no additional epidemiological links were identified, all four cases resided within a 6.6 km radius. WGS analysis showed that the four cases were part of an 11-case cluster. Screening of HCW (n = 197) identified two individuals carrying clonally related S. pyogenes isolates. Conclusions Collaboration between hospital, PHS, and NRLBM resulted in an overview of possible epidemiological links. Centralized collection of iGAS case information and strain typing are critical to place hospital clusters in the context of local epidemiology. An increase in healthcare-associated infections may not necessarily imply in-hospital transmission.https://doi.org/10.1186/s13756-025-01564-zS. pyogenesGroup A StreptococcusInfectionPuerperal sepsisMolecular typingWhole-Genome sequencing |
| spellingShingle | Irene V. Hoogendijk Diane de Zwart - Slats Stefan A. Boers Boas C.L. van der Putten Nina M. van Sorge Bibi D.H. Molenaar Myrthe M.A. Toorop Marieke B. Veenhof Karin Ellen Veldkamp Adriënne S. van der Schoor Joffrey van Prehn Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis Antimicrobial Resistance and Infection Control S. pyogenes Group A Streptococcus Infection Puerperal sepsis Molecular typing Whole-Genome sequencing |
| title | Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis |
| title_full | Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis |
| title_fullStr | Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis |
| title_full_unstemmed | Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis |
| title_short | Value of collaborative investigation by hospital infection control, public health services and a national reference laboratory during an increase in puerperal sepsis |
| title_sort | value of collaborative investigation by hospital infection control public health services and a national reference laboratory during an increase in puerperal sepsis |
| topic | S. pyogenes Group A Streptococcus Infection Puerperal sepsis Molecular typing Whole-Genome sequencing |
| url | https://doi.org/10.1186/s13756-025-01564-z |
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