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Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burns units of a new hospital

Published online by Cambridge University Press:  15 May 2009

M. Farrington ,
J. Ling ,
T. Ling  and
G. L. French
M. Farrington
Affiliation:
Clinical Microbiology and Public Health Laboratory, The John Bonnett Clinical Laboratories, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
J. Ling
Affiliation:
Department of Microbiology, Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, New Territories, Hong Kong
T. Ling
Affiliation:
Department of Microbiology, Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, New Territories, Hong Kong
G. L. French
Affiliation:
Department of Microbiology, Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Summary

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Multiple introductions of methicillin-resistant Staphylococcus aureus (MRSA) strains occurred to a new hospital in Hong Kong. Two years of clinical microbiological surveillance of the resulting outbreaks was combined with laboratory investigation by phage and antibiogram typing, and plasmid profiling. The outbreaks on the special care baby (SCBU) and burns (BU) units were studied in detail, and colonization of staff and contamination of the environment were investigated. MRSA were spread by the hands of staff on the SCBU, where long-term colonization of dermatitis was important, but were probably transmitted on the BU by a combination of the airborne, transient hand-borne and environmental routes. Simple control measures to restrict hand-borne spread on the SCBU were highly effective, but control was not successful on the BU.

Type
Research Article
Information
Epidemiology & Infection , Volume 105 , Issue 2 , October 1990 , pp. 215 - 228
Copyright
Copyright © Cambridge University Press 1990

References

REFERENCES

1.Hutchinson, JGP. Breast abscess as a threat to surgical units in a general hospital. Brit Med J 1959; 2: 277–9CrossRefGoogle Scholar
2.Jevons, MR. ‘Celbenin’-resistant staphylococci. Br Med J 1961; 1: 124–5.CrossRefGoogle Scholar
3.Keane, CT, Cafferkey, MT. Re-emergence of methicillin-resistant Staphylococcus aureus causing severe infection. J Infect 1984; 9: 6–16.CrossRefGoogle ScholarPubMed
4.Shanson, DC. Antibiotic-resistant Staphylococcus aureus. J Hosp Infect 1981; 2: 11–36.CrossRefGoogle ScholarPubMed
5.French, GL, Ling, J, Hui, YW, Farrington, M. Epidemiology of methicillin-resistant Staphylococcus aureus in a new Hong Kong hospital investigated by plasmid-profiling. J Hosp Infect 1990. In press.Google Scholar
6.Espersen, F, Nielsen, PB, Lund, K, Sylvest, B, Jensen, K. Hospital-acquired infections in a burns unit caused by an imported strain of Staphylococcus aureus with unusual multi-resistance. J Hyg 1982; 88: 535–41.Google Scholar
7.Pearman, JW, Christiansen, KJ, Annear, DI et al. , Control of methicillin-resistant Staphylococcus aureus (MRSA) in an Australian metropolitan teaching hospital complex. Med J Aust 1985; 142: 103–8.CrossRefGoogle Scholar
8.Cheng, AF, French, GL. Methicillin-resistant Staphylococcus aureus bacteraemia in Hong Kong. J Hosp Infect 1988; 12: 91–101.Google Scholar
9.Hong Kong MRSA Study Group. Methicillin-resistant Staphylococcus aureus in Hong Kong hospitals. J Hosp Infect 1990. In press.Google Scholar
10.Casewell, MW. Epidemiology and control of the ‘modern’ methicillin-resistant Staphylococcus aureus. J Hosp Infect 1986; 7 (Suppl A): 1–11.Google Scholar
11.Duckworth, GJ, Lothian, JLE, Williams, JD. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect 1988; 11: 1–15.CrossRefGoogle Scholar
12.Health Commission of Victoria. Staphylococcal infections in hospitals, 2nd edn.Melbourne, Victoria. 1981.Google Scholar
13.Report of a combined working party of the Hospital Infection Society and the British Society for Antimicrobial Chemotherapy. Guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect 1986; 7: 193–201.CrossRefGoogle Scholar
14.Spicer, WJ. Three strategies in the control of staphylococci including methicillin-resistant Staphylococcus aureus. J Hosp Infect 1984; 5 (Suppl A): 45–9.CrossRefGoogle ScholarPubMed
15.French, GL, Ling, J, Hui, YW, Oo, HKT. Determination of methicillin resistance in Staphylococcus aureus by agar dilution and disc diffusion methods. J Antimicrob Chemother 1987; 20: 599–608.CrossRefGoogle ScholarPubMed
16.French, GL, Ling, J, Ling, T, Hui, YW. Susceptibilities of Hong Kong isolates of methicillin-resistant Staphylococcus aureus to anti-staphylococcal agents. J Antimicrob Chemother 1988; 21: 581–8.CrossRefGoogle Scholar
17.Dunkle, LM, Naqvi, SH, McCallum, R, Lofgren, JP. Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensive care nursery. Amer J Med 1981; 70: 455–8.CrossRefGoogle Scholar
18.Richardson, JF, Chittasobhon, N, Marples, RR. Supplementary phages for the investigation of strains of methicillin-resistant Staphylococcus aureus. J Med Microbiol 1988; 25: 67–74.Google Scholar
19.Gaston, MA, Duff, PS, Naidoo, J et al. , Evaluation of electrophoretic methods for typing methicillin-resistant Staphylococcus aureus. J Med Microbiol 1988; 26: 189–97.CrossRefGoogle ScholarPubMed
20.Beard-Pegler, MA, Stubbs, E, Vickery, AM. Observations on the resistance to drying of Staphylococcal strains. J Med Microbiol 1988; 26: 251–5.Google Scholar
21.Filho, PPG, Stumpf, M, Cardoso, CL. Survival of Gram-negative and Gram-positive bacteria artificially applied on the hands. J Clin Microbiol 1985; 21: 652–3.Google Scholar
22.Mortimer, EA, Wolinsky, E, Gonzaga, AJ, Rammelkamp, CH. Role of airborne transmission in Staphylococcal infections. Brit Med J 1966; 1: 319–22.Google Scholar
23.Michel, MF, Priem, CC. Control at hospital level of infections by methicillin-resistant staphylococci in children. J Hyg 1971; 69: 453–60.CrossRefGoogle ScholarPubMed
24.Price, EH, Brain, A, Dickson, JAS. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect 1980; 1: 221–8.CrossRefGoogle Scholar
25.Graham, DR, Correa-Villasenor, A, Anderson, RL, Vollman, JH, Baine, WB. Epidemic gentamicin-methicillin-resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin. J Pediatr 1980; 97: 972–8.CrossRefGoogle ScholarPubMed
26.Dunkle, LM, Sipple, CJ. Rapid microprocedure for extraction of plasmid DNA from Staphylococcus aureus. J Infect Dis 1984; 149: 921–3.Google Scholar
27.Trallero, EP, Arenzana, JG, Castaneda, AA, Grisolia, LP. Unusual multiresistant Staphylococcus aureus in a newborn nursery. Amer J Dis Child 1981; 135: 689–92.Google Scholar
28.Gilbert, GL, Asche, V, Hewstone, AS, Mathiesen, JL. Methicillin-resistant Staphylococcus aureus in neonatal nurseries. Med J Aust 1982; 1: 455–9.Google Scholar
29.Hill, SF, Ferguson, D. Multiply-resistant Staphylococcus aureus (bacteriophage type 90) in a special care baby unit. J Hosp Infect 1984; 5: 56–62.CrossRefGoogle Scholar
30.Lejeune, B, Buzit-Losquin, F, Simitzis-Le, Flohic AM, Le Bras, MP, Alix, D. Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children. J Hosp Infect 1986; 7: 21–5.Google Scholar
31.Ribner, BS. Endemic, multiply resistant Staphylococcus aureus in a pediatric population. Amer J Dis Child 1987; 141: 1183–7.Google Scholar
32.Mulhern, B, Griffin, E. An epidemic of gentamicin/cloxacillin resistant staphylococcal infection in a neonatal unit. Irish Med J 1987; 74: 228–9.Google Scholar
33.Davies, EA, Emmerson, AM, Hogg, GM, Patterson, MF, Shields, MD. An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control. J Hosp Infect 1987; 10: 120–8.Google Scholar
34.Reboli, AC, John, JF, Levkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. Amer J Dis Child 1989; 143: 34–9.Google Scholar
35.Parks, YA, Noy, MF, Aukett, MA, Webb, CA. Methicillin resistant Staphylococcus aureus in milk. Arch Dis Child 1987; 62: 82–4.CrossRefGoogle ScholarPubMed
36.Lemoine, L. Possible transmission of methicillin-resistant Staphylococcus aureus by expressed human breast milk. J Hosp Infect 1987; 9: 93–4.Google Scholar
37.Bruun, JN, Solberg, CO. Hand carriage of gram-negative bacilli and Staphylococcus aureus. Brit Med J 1973; 2: 580–2.Google Scholar
38.Hone, R, Keane, CT. Faecal carriage of Staphylococcus aureus in infantile enteritis due to enteropathogenic Escherichia coli. Scand J Infect Dis 1974; 6: 329–32.CrossRefGoogle Scholar
39.Shaffer, TE, Baldwin, JN, Wheeler, WE. Staphylococcal infections in nurseries. Advanc Pediatr 1958; 10: 243–81.Google Scholar
40.Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special care unit. J Infect Dis 1982; 145: 875–85.CrossRefGoogle Scholar
41.Morrison, AJ, Kaiser, DL, Wenzel, RP. A measurement of the efficacy of nosocomial infection control using the 95 per cent confidence interval for infection rates. Amer J Epidemiol 1987; 126:292–7.CrossRefGoogle ScholarPubMed
42.Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis 1979; 139: 273–9.Google Scholar
43.Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979; 139: 280–7.Google Scholar
44.Locksley, RM, Cohen, ML, Quinn, TC, Tompkins, LS, Coyle, MB, Kirihara, JS, Counts, GW. Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Int Med 1982; 97: 317–24.CrossRefGoogle ScholarPubMed
45.Linnemann, CC, Mason, M, Moore, P, Korfhagen, TR, Staneck, JL. Methicillin-resistant Staphylococcus aureus: experience in a general hospital over four years. Amer J Epidemiol 1982; 115: 941–50.CrossRefGoogle Scholar
46.Arnow, PM, Allyn, PA, Nichols, EM, Hill, DL, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982; 22: 954–9.CrossRefGoogle Scholar
47.Boyce, JM, White, RL, Causey, WA, Lockwood, WR. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. J Amer Med Assoc 1983; 249: 2803–7.Google Scholar
48.Baird, DR. Methicillin-resistant Staphylococcus aureus in Glasgow. Communicable Diseases Scotland Weekly Report 1985; 19 (40): 5–8.Google Scholar
49.Hunt, JL, Purdue, GF, Tuggle, DW. Morbidity and mortality of an endemic pathogen: methicillin-resistant Staphylococcus aureus. Amer J Surg 1988; 156: 524–8.CrossRefGoogle ScholarPubMed
50.Lidwell, OM, Davis, J, Payne, RW, Newman, P, Williams, REO. Nasal acquisition of Staphylococcus aureus in partly divided wards. J Hyg 1971; 69: 113–23.CrossRefGoogle ScholarPubMed
51.Maley, MP. Methicillin-resistant Staphylococcus aureus. Lancet 1985; ii: 605.CrossRefGoogle Scholar
52.Hambraeus, A. Spread of Staphylococcus aureus in a burns unit. Acta Universitas Uppsaliensis: Abstracts of Uppsala Dissertations from the Department of Medicine [Dissertation] 1973; 158: 5–23.Google Scholar
53.Melo, Cristono JAG, Torres, Periera AT, Afonso, F, Naidoo, J. Methicillin-resistant Staphylococcus aureus: a 6-month survey in a Lisbon paediatric hospital. J Hyg 1986; 97: 265–72.Google Scholar
54.Sieger, BE, Long, JM, Lindberg, RB, Pruitt, BA, McNitt, TR. Methicillin resistant staphylococci in thermally injured patients: epidemiologic aspects. 16th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy Chicago, 1976; Abstract 282.Google Scholar
55.Everett, ED, McNitt, TR, Rahm, AE, Stevens, DL, Peterson, HE. Epidemiologic investigation of methicillin resistant Staphylococcus aureus in a burn unit. Milit Med 1978; 143: 165–7.Google Scholar
56.Ransjö, U, Malm, M, Hambraeus, A, Artursson, G, Hedlund, A. Methicillin-resistant Staphylococcus aureus in two burn units: clinical significance and epidemiological control. J Hosp Infect 1989; 13: 355–65.CrossRefGoogle ScholarPubMed
57.Cookson, BD, Farrington, M, Webster, M, Phillips, I. Methicillin resistant Staphylococcus aureus. Lancet, 1985; ii: 218–9.CrossRefGoogle Scholar
58.Aly, R, Maibach, HI, Shinefield, HR, Mandel, A, Strauss, WG. Bacterial interference among strains of Staphylococcus aureus in man. J Infect Dis 1974; 129: 720–4.CrossRefGoogle ScholarPubMed
59.Zierdt, CH. Long-term Staphylococcus aureus carrier state in hospital patients. J Clin Microbiol 1982; 16: 517–20.Google Scholar
60.O'Grady, F, Wittstadt, FB. Nasal carriage of Staphylococcus pyogenes. I. Lability of carriage in relation to carrier state, environmental load, and antibiotic therapy. Amer J Hyg 1962; 75: 136–45.Google Scholar
61.Berntson, CA, McDermott, W. Increased transmissibility of staphylococci to patients receiving an antimicrobial drug. N Engl J Med 1960; 262: 637–42.Google Scholar
62.Rosdahl, VT, Laursen, H, Bentzon, MW, Kjaeldgaard, P, Thomsen, M. Colonization priority among Staphylococcus aureus strains–correlation with phage-type. J Hosp Infect 1988; 12: 151–62.CrossRefGoogle ScholarPubMed