Investigation of a cluster of Pseudomonas aeruginosa folliculitis cases at a hotel in Southern Corsica. November 2004

Introduction. Community-acquired outbreaks of Pseudomonas aeruginosa folliculitis are rarely reported. On November 23, 2004, a cluster of folliculitis cases was reported among individuals who had stayed at a hotel in Southern Corsica in mid-November 2004. A sample taken from a guest’s lesions tested positive for Pseudomonas aeruginosa. The Directorate of Solidarity and Health for Corsica and Southern Corsica (DSS) conducted an environmental investigation and referred the case to the Southern Interregional Epidemiology Unit (Cire) for epidemiological investigation. Method. A retrospective cohort study was initiated. A case was defined as any person who stayed at the hotel from November 7 to 16, 2004, at noon and who presented clinical signs, notably a skin rash, up to 4 days after departure. Hotel guests were interviewed by telephone. Results. Of a total of 80 guests, 59 individuals were included in the analysis. Sixteen individuals met the case definition (incidence rate: 27%) and developed the first clinical signs between November 13 and 17, with a peak on the 15th. In the univariate analysis, individuals under 34.5 years of age had a 2.7 [1.2–5.9] times higher risk of developing folliculitis than older individuals. The relative risk (RR) could not be calculated for spa exposure, but the attack rate (AR) among exposed individuals was 44% versus 0% among unexposed individuals (p<0.0002). The RR among individuals exposed to the sauna was 3.4 [1.4–8.6] and 3.1 [1.1–9.5] for those exposed to the steam room. Stratified analysis by days of spa exposure showed an elevated RR starting on November 11, peaking on the 13th (RR = 11 [3–43]). The risk of developing folliculitis increased with the duration of spa exposure (p=0.05). Multivariate analysis identified total time spent in the spa as the sole risk factor (RR=42 [4.7–387] for a total duration of more than 30 minutes versus less than 11 minutes). Discussion. These results support the strong hypothesis that Pseudomonas aeruginosa folliculitis occurred as a result of spa use. This contamination was likely linked to the presence of a person with folliculitis who reported using the spa, combined with high usage by hotel guests and a lack of daily maintenance of the facility. Recommendations were made: limiting the number of bathers, daily maintenance, implementing a health log, and prohibiting access to bathers with dermatitis.

Author(s): Gourvellec G

Publishing year: 2006

Pages: 28 p.

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