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Failure to Control an Outbreak of Multidrug-Resistant Streptococcus pneumoniae in a Long-Term–Care Facility Emergence and Ongoing Transmission of a Fluoroquinolone-Resistant Strain

Published online by Cambridge University Press:  21 June 2016

Rosalind J. Carter
Affiliation:
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, New York Epidemic Intelligence Service, Division of Applied Public Health Training, State Branch, Epidemiology Program Office, Atlanta, Georgia
Genevieve Sorenson
Affiliation:
St. Elizabeth Ann's Health Care and Rehabilitation Center, Staten Island, New York
Richard Heffernan
Affiliation:
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, New York
Julia A. Kiehlbauch
Affiliation:
Wadsworth Center, New York State Department of Health, Albany, New York
John S. Kornblum
Affiliation:
Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York
Robert J. Leggiadro
Affiliation:
St. Vincent's Medical Center, Staten Island, New York
Lucia J. Nixon
Affiliation:
St. Elizabeth Ann's Health Care and Rehabilitation Center, Staten Island, New York
William A. Wertheim
Affiliation:
State University of New York at Stonybrook, Stonybrook, New York
Cynthia G. Whitney
Affiliation:
Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Marcelle Layton
Affiliation:
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, New York
Corresponding
E-mail address:

Abstract

Objectives:

To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term–care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain.

Design:

Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance.

Setting:

An 80-bed AIDS-care unit in an LTCF.

Participants:

Staff and residents on the unit.

Results:

From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n = 65) and staff (n = 70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized.

Conclusions:

Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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Failure to Control an Outbreak of Multidrug-Resistant Streptococcus pneumoniae in a Long-Term–Care Facility Emergence and Ongoing Transmission of a Fluoroquinolone-Resistant Strain
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