Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-01T02:44:27.524Z Has data issue: false hasContentIssue false
  • English
  • Français

An Outbreak of Staphylococcus aureus in a Pediatric Cardiothoracic Surgery Unit

Published online by Cambridge University Press:  02 January 2015

Stefan Weber ,
Loreen A. Herwaldt ,
Louise-Anne McNutt ,
Paul Rhomberg ,
Pierre Vaudaux ,
Michael A. Pfaller  and
Trish M. Perl
Stefan Weber
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
Loreen A. Herwaldt*
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Louise-Anne McNutt
Affiliation:
Department of Epidemiology, University at Albany, State University of New York, Rensselaer, New York
Paul Rhomberg
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Pierre Vaudaux
Affiliation:
Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
Michael A. Pfaller
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Trish M. Perl
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
*
Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1081
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate an outbreak of Staphylococcus aureus surgical-site infections.

Design:

Case–control study.

Setting:

Pediatric cardiothoracic surgery service of a tertiary-care university medical center.

Method:

Molecular typing was used to identify healthcare workers who carried the epidemic strain.

Results:

Three children acquired surgical-site infections caused by a single strain of S. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P = 01). A case–control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not grow S. aureus.

Conclusions:

Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 2 , February 2002 , pp. 77 - 81
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Edwards, MS, Baker, CJ. Median sternotomy wound infections in children. Pediatr Infect Dis J 1993;2:105–109.Google Scholar
2.Hedley-Brown, A, Braimbridge, MV, Panagopoulos, P, Sabar, EF. The complications of median sternotomy. J Thorac Cardiovasc Surg 1969;58:189–197.Google Scholar
3.Culliford, AT, Cunningham, JN, Zeff, RH, Isom, OW, Teiko, P, Spencer, FC. Sternal and costochondral infections following open-heart surgery: a review of 2,594 cases. J Thorac Cardiovasc Surg 1976;72:714–726.Google Scholar
4.Grmoljez, PF, Barner, HH, Willman, VL, Kaiser, GC. Major complications of median sternotomy. Am J Surg 1975;130:679–681.Google Scholar
5.Barois, A, Grosbuis, S, Simon, N, et al. Treatment of mediastinitis in children after cardiac surgery: a study of 20 cases. Intensive Care Medicine 1978;4:35–39.CrossRefGoogle ScholarPubMed
6.Ruef, C, Fanconi, S, Nadal, D. Sternal wound infection after heart operations in pediatric patients associated with nasal carriage of Staphylococcus aureus. J Thorac Cardiovasc Surg 1996;112:681–686.Google Scholar
7.Devenish, EA, Miles, AA. Control of Staphylococcus aureus in an operating theater. Lancet 1939;i:1088–1094.Google Scholar
8.Sherertz, RJ, Reagan, DR, Hampton, KD, et al. A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med 1996;124:539–547.Google Scholar
9.Broderick, A, Mori, M, Nettleman, MD, Streed, SA, Wenzel, RP. Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk. Am J Infect Control 1990;131:734–742.Google Scholar
10.U.S. Department of Health, Education, and Welfare. Outline for Surveillance and Control of Nosocomial Infections. Atlanta, GA; Center for Disease Control; 1972.Google Scholar
11.Doebbeling, B, Pfaller, M, Houston, A, Wenzel, R. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988;109:394–398.CrossRefGoogle ScholarPubMed
12.Pfaller, MA, Hollis, RJ, Sader, HS. Chromosomal restriction fragment analysis by pulsed-field gel electrophoresis. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook, supplement 1. Washington, DC: ASM Press; 1992:10.5.c.1–10.6.3.Google Scholar
13.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
14.Bisognano, C, Vaudaux, PE, Lew, DP, Ng, EY, Hooper, DC. Increased expression of fibronectin-binding proteins by fluoroquinolone-resistant Staphylococcus aureus exposed to subinhibitory levels of ciprofloxacin. Antimicrob Agents Chemother 1997;41:906–913.Google Scholar
15.Williams, REO. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriological Reviews 1963;27:56–71.Google Scholar
16.Reagan, DR, Doebbeling, BN, Pfaller, MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.Google Scholar
17.McAnnally, TP, Lewis, MR, Brown, DR. Effect of rifampin and bacitracin on nasal carriers of Staphylococcus aureus. Antimicrob Agents Chemother 1984;25:422–426.CrossRefGoogle Scholar
18.Peacock, JE, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.Google Scholar
19.Belani, A, Sherertz, RJ, Sullivan, ML, Russell, BA, Reumen, PD. Outbreak of staphylococcal infection in two hospital nurseries traced to a single nasal carrier. Infect Control 1986;7:487–490.Google Scholar
20.Nakashima, AK, Allen, JR, Martone, WJ, et al. Epidemic bullous impetigo in a nursery due to a nasal carrier of Staphylococcus aureus: role of epidemiology and control measures. Infect Control 1984;5:326–331.Google Scholar
21.Cox, RA, Conquest, C, Mallaghan, C, Marples, RRA major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 1995;29:87–106.Google Scholar
22.Fang, FC, McClelland, M, Guiney, DG, et al. Value of molecular epidemiologic analysis in a nosocomial methicillin-resistant Staphylococcus aureus outbreak. JAMA 1993;270:1323–1328.Google Scholar
23.Casewell, MW. Epidemiology and control of the ‘modern’ methicillin-resistant Staphylococcus aureus. J Hosp Infect 1986;7(suppl. A):1–11.Google Scholar
24.Huytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.Google Scholar
25.Payne, RW. Severe outbreak of surgical sepsis due to Staphylococcus aureus of unusual type and origin. Br Med J 1967;4:17–20.Google Scholar
26.Walter, CW. The infector on the surgical team. Clin Neurosurg 1966;14:361–379.Google Scholar
27.Back, NA, Linnemann, CC, Pfaller, MA, et al. Recurrent epidemics caused by a single strain of erythromycin-resistant Staphylococcus aureus. JAMA 1993;270:1329–1333.Google Scholar