A Strep Nobody Was Tracking: Group G Streptococcus in a Pennsylvania Nursing Home, 2024

Group A strep outbreaks in nursing homes are well known, and there are tried tools for stopping them. Group G β-hemolytic Streptococcus (GGS) is usually a harmless resident of the body, but it is increasingly recognized as a cause of invasive disease after soft-tissue infections such as cellulitis — and in Pennsylvania, unlike group A, it is not reportable. In late 2024, one Pennsylvania skilled nursing facility showed what it can do.

Two residents, one death

In November 2024, the Pennsylvania Department of Health learned of two positive GGS blood cultures from residents of the same facility, both receiving wound care. Both were women over 85 with other illnesses, hospitalized with sepsis and cellulitis:

• Patient A, a resident since 2021, with a long-term bladder catheter and cellulitis, recovered and returned to the facility.
• Patient B, a resident since October 2024, with heart failure, multiple myeloma, chronic deep vein thrombosis and cellulitis, died a day after being admitted to hospital.

With no established guidance for GGS, the health department used its group A strep protocol for a site visit in December 2024.

What inspectors saw

Finding the carriers

In January 2025, the 12 other residents getting wound care (of 70 residents) were screened — throat swabs from all 12 and 15 wound swabs from nine — along with throat swabs from the two staff who did wound care. Two residents carried GGS in their wounds; all throat swabs were negative.

Both carriers took 10 days of oral cephalexin, as group A guidance recommends, but were still positive 30 days later. A second 10-day course — ampicillin for one, ciprofloxacin for the other — cleared them.

One source

CDC sequenced the four isolates: the two from the blood of patients A and B and the two from the carriers' wounds. All were emm type 2574.3 and a previously undescribed sequence type, 525, differing by only 1–2 single nucleotide polymorphisms — a common source, and likely spread within the facility through poor infection control.

What it means

A search of the English-language literature found no earlier report of an invasive GGS outbreak in a U.S. long-term care facility. It looked like a group A outbreak in every way — very old patients, chronic illness, open wounds, carriers sharing the same staff, severe outcomes — and the group A playbook worked: no further GGS infections were reported. The authors suggest health departments consider tracking GGS clusters, and that tools built for group A can likely be used for other β-hemolytic strep outbreaks in long-term care.

Sources

Based on Giacomucci M, Modali L, Kinsey CB, Warren K, Chochua S, Gregory CJ, Longenberger A, "Notes from the Field: Invasive Group G β-Hemolytic Streptococcus Outbreak at a Long-Term Care Facility — Pennsylvania, 2024," MMWR Morbidity and Mortality Weekly Report volume 74, number 34, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The imported copy was cut short; the missing text is from the report's full text in PubMed Central (PMC12425176).