Flesh eating bacteria

Two cases of what has become a fearsome infection--known to the public as the "flesh-eating disease" and to doctors as "necrotizing fasciitis"--were transmitted mysteriously in an Evanston Hospital operating room in late July, hospital officials said Monday.

Doctors at an afternoon press conference at the hospital said it is impossible to predict infections like the ones that hit two mothers who had Caesarean-section deliveries at the hospital.

"This is a very rare event; there have been only 15 outbreaks [after birth or surgery in a hospital] in the last 35 years. This is not something that has been very well studied," said Dr. Thomas Vescio, the hospital's medical director, infection control and epidemiology.

He said doctors feel sure they have identified the carrier, but it's not known how the Group A streptococcus bacteria that causes the disease were transmitted.

The women had their C-sections in the same operating room on July 31, and both later quickly developed the serious Group A strep infections, doctors said at a hospital press conference.

Both patients had surgery to treat the infections. One has gone home and the other is expected to go home shortly.

No other cases have been identified at the hospital.

Officials refused to identify the mothers, citing patient confidentiality.

It is still a mystery how the bacteria got to the mothers, but the exact strain--containing the same DNA--was traced to the intestinal system of one member of the operating room team present for both deliveries.

Officials would not say whether the person was a doctor, nurse or other member of the team but Vescio emphasized the person, who had no symptoms, could not have known about the organism's presence.

Doctors conceded they are left with one big question: How did the bacteria get from the carrier's gut to the mothers?

Vescio said skin transmission was considered very unlikely. The general hypothesis is the spread is airborne in such cases, he said, although he called that idea "somewhat controversial."

The employee tested positive on a rectal culture, was treated with antibiotics and is now strep-free.

That person will not be barred from the operating room in the future, a hospital spokeswoman said.

"I don't believe that anyone is to blame for this, for what happened," Vescio said.

Vescio said there was "no break in technique" and no violation of procedures found that could have allowed the organism to transfer to the women.

Trying to track the source of the infection, the hospital took vaginal, rectal and throat cultures from all the people in the operating room during the C-sections--about eight on one team and a dozen in the other.

That was how they found the one infected individual, who was then furloughed and treated with antibiotics, officials said.

Even prestigious hospitals have had cases of the disease, Vescio said.

"Unfortunately, in the future and throughout the world, this is going to happen at other hospitals. That's just the way it is," he said. "No matter how good your institution is, these things will happen."

The Illinois Department of Public Health is investigating and hopes to have the inquiry completed this week, said spokesman Tom Schafer.

In 2000, Illinois saw 224 cases of invasive disease caused by Group A strep and five were necrotizing fasciitis. In 1999, there were 273 invasive cases and 10 were necrotizing fasciitis.

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