We've blogged before about LTACHs (long-term acute care hospitals) and the role they play in amplifying and disseminating multi-drug resistant pathogens. A recent report in Clinical Infectious Diseases describes an LTACH outbreak of group A streptococcus, which is arguably one of the most antibiotic susceptible (though highly virulent) pathogens. In this 57-bed facility there were 11 cases, 8 of which were bacteremic, and of which 2 died. The outbreak continued for 4 months. The report notes poor infection control practices and a delayed recognition of an outbreak by infection prevention personnel in the facility. The editorial accompanying the paper is also worth reading. Given what we know about LTACHs and their patient population, it may be wise for acute care hospitals who receive transfers from LTACHs to initiate empiric contact precautions for these patients until the patients can be fully evaluated (and those of you who know my feelings about contact precautions know that I almost never argue in support of contact precautions).