{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T14:59:54Z","timestamp":1778338794777,"version":"3.51.4"},"reference-count":50,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2009,5,15]],"date-time":"2009-05-15T00:00:00Z","timestamp":1242345600000},"content-version":"unspecified","delay-in-days":4914,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[1995,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>We 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) of<jats:italic>Streptococcus pyogenes<\/jats:italic>NF 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 5<jats:italic>S. pyogenes<\/jats:italic>isolates there were 2 M1 strains, 1 M3, 1 M5 and 1 M non-typeable strain.<jats:italic>S. pyogenes<\/jats:italic>NF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence of<jats:italic>S. pyogenes<\/jats:italic>bacteraemia in England and Wales had not risen in the past 5 years.<\/jats:p><jats:p>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 of<jats:italic>S. pyogenes<\/jats:italic>infection 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 with<jats:italic>S. pyogenes<\/jats:italic>. Regular, routine screening of theatre staff is neither practical nor necessary.<\/jats:p>","DOI":"10.1017\/s0950268800058544","type":"journal-article","created":{"date-parts":[[2009,5,15]],"date-time":"2009-05-15T08:38:04Z","timestamp":1242376684000},"page":"387-397","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":35,"title":["A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire"],"prefix":"10.1017","volume":"115","author":[{"given":"K.","family":"Cartwright","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Logan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"McNulty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"George","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Efstratiou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"McEvoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Begg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2009,5,15]]},"reference":[{"key":"S0950268800058544_ref026","doi-asserted-by":"publisher","DOI":"10.1007\/BF00383496"},{"key":"S0950268800058544_ref049","first-page":"256","volume-title":"Pathogenic streptococci: present and future","author":"Vesela","year":"1994"},{"key":"S0950268800058544_ref013","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90629-7"},{"key":"S0950268800058544_ref014","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198907063210101"},{"key":"S0950268800058544_ref004","first-page":"345","article-title":"Gangrene foudroyant de la verge","volume":"3","author":"Fournier","year":"1883","journal-title":"Semaine Med"},{"key":"S0950268800058544_ref012","first-page":"304","article-title":"Implications of risk factors in necrotizing fasciitis","volume":"59","author":"Francis","year":"1993","journal-title":"Am Surg"},{"key":"S0950268800058544_ref036","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(66)92931-X"},{"key":"S0950268800058544_ref003","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90574-6"},{"key":"S0950268800058544_ref033","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1965.10664166"},{"key":"S0950268800058544_ref037","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(68)90056-2"},{"key":"S0950268800058544_ref023","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4049\/jimmunol.89.3.307","article-title":"Current knowledge of type-specific M antigens of group A streptococci","volume":"89","author":"Lancefield","year":"1962","journal-title":"J Immunol"},{"key":"S0950268800058544_ref020","doi-asserted-by":"publisher","DOI":"10.3109\/00365549009027073"},{"key":"S0950268800058544_ref001","first-page":"416","article-title":"Necrotising fasciitis","volume":"18","author":"Wilson","year":"1952","journal-title":"Am J Surg"},{"key":"S0950268800058544_ref009","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197012000-00005"},{"key":"S0950268800058544_ref011","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(77)90283-5"},{"key":"S0950268800058544_ref029","first-page":"97","article-title":"Invasive group A streptococcal infections in Gloucestershire","volume":"4","year":"1994","journal-title":"Commun Dis Rep"},{"key":"S0950268800058544_ref050","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800068461"},{"key":"S0950268800058544_ref016","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1982.01380290029006"},{"key":"S0950268800058544_ref045","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/77.2.96"},{"key":"S0950268800058544_ref002","first-page":"24","volume-title":"Hippocrates","volume":"1","author":"Jones","year":"1957"},{"key":"S0950268800058544_ref032","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520010026011"},{"key":"S0950268800058544_ref027","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)90339-5"},{"key":"S0950268800058544_ref005","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1924.01120080083007"},{"key":"S0950268800058544_ref039","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1970.03170330069015"},{"key":"S0950268800058544_ref006","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197205000-00010"},{"key":"S0950268800058544_ref035","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199010043231406"},{"key":"S0950268800058544_ref046","first-page":"239","volume-title":"Topley and Wilson's principles of bacteriology, virology and immunity","volume":"3","author":"Ross","year":"1990"},{"key":"S0950268800058544_ref021","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)92777-F"},{"key":"S0950268800058544_ref043","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1982.03320440028027"},{"key":"S0950268800058544_ref007","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198105000-00003"},{"key":"S0950268800058544_ref041","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(77)80698-7"},{"key":"S0950268800058544_ref008","first-page":"808","volume-title":"Principles and practice of infectious diseases","author":"Swartz","year":"1990"},{"key":"S0950268800058544_ref010","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.1983.tb03989.x"},{"key":"S0950268800058544_ref025","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.88.7.2668"},{"key":"S0950268800058544_ref018","doi-asserted-by":"publisher","DOI":"10.1007\/BF01659058"},{"key":"S0950268800058544_ref019","volume-title":"Enquete sur les bacteriemies A streptocoque du group A. Internal publication of the Reseau National de Sante Publique","author":"Goulet","year":"1994"},{"key":"S0950268800058544_ref022","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/164.3.595"},{"key":"S0950268800058544_ref028","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)92518-6"},{"key":"S0950268800058544_ref031","volume-title":"A dictionary of epidemiology","author":"Last","year":"1988"},{"key":"S0950268800058544_ref040","first-page":"141","article-title":"Hospital outbreak of streptococcal wound infection \u2013 Utah","volume":"25","year":"1976","journal-title":"MMWR"},{"key":"S0950268800058544_ref042","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/138.3.287"},{"key":"S0950268800058544_ref044","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(91)90391-A"},{"key":"S0950268800058544_ref048","doi-asserted-by":"crossref","first-page":"3369","DOI":"10.1128\/IAI.61.8.3369-3374.1993","article-title":"Association of phenotypic and genotypic characteristics of invasive Streptococcus pyogenes isolates with clinical components of streptoccal toxic shock syndrome","volume":"61","author":"Talkington","year":"1993","journal-title":"Infect Immun"},{"key":"S0950268800058544_ref034","first-page":"63","article-title":"Streptococcal wound infections","volume":"63","author":"Zimmerman","year":"1966","journal-title":"Rocky Mt Med J"},{"key":"S0950268800058544_ref024","doi-asserted-by":"publisher","DOI":"10.1099\/00222615-39-3-165"},{"key":"S0950268800058544_ref030","first-page":"123","article-title":"Invasive group A streptococcal infection \u2013 update","volume":"4","year":"1994","journal-title":"Commun Dis Rep"},{"key":"S0950268800058544_ref038","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196905292802209"},{"key":"S0950268800058544_ref047","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)91112-8"},{"key":"S0950268800058544_ref017","first-page":"488","article-title":"Necrotising fasciitis: 10 years' experience in a district general hospital","volume":"78","author":"Ward","year":"1991","journal-title":"Surg"},{"key":"S0950268800058544_ref015","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800620510"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268800058544","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T11:03:54Z","timestamp":1710327834000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268800058544\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1995,12]]},"references-count":50,"journal-issue":{"issue":"3","published-print":{"date-parts":[[1995,12]]}},"alternative-id":["S0950268800058544"],"URL":"https:\/\/doi.org\/10.1017\/s0950268800058544","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,12]]},"assertion":[{"value":"Cambridge University Press 1995","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}