Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T20:40:44.564Z Has data issue: false hasContentIssue false
  • English
  • Français

Control of Epidemic Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  21 June 2016

Katherine A. Murray-Leisure ,
Sandra Geib ,
Diane Graceley ,
Arline B. Rubin-Slutsky ,
Narendra Saxena ,
H. Arnold Muller  and
Bruce H. Hamory
Katherine A. Murray-Leisure*
Affiliation:
Lebanon Veterans' Administration Medical Center, Lebanon, Pennsylvania
Sandra Geib
Affiliation:
Lebanon Veterans' Administration Medical Center, Lebanon, Pennsylvania
Diane Graceley
Affiliation:
Lebanon Veterans' Administration Medical Center, Lebanon, Pennsylvania
Arline B. Rubin-Slutsky
Affiliation:
Lebanon Veterans' Administration Medical Center, Lebanon, Pennsylvania
Narendra Saxena
Affiliation:
Lebanon Veterans' Administration Medical Center, Lebanon, Pennsylvania
H. Arnold Muller
Affiliation:
Lebanon Veterans' Administration Medical Center, Lebanon, Pennsylvania
Bruce H. Hamory
Affiliation:
Pennsylvania State University School of Medicine, Hershey, Pennsylvania
*
Infectious Diseases Section, Department of Medicine (111), Lebanon Veterans' Administration Medical Center, Zeban, PA 17042
Get access Rights & Permissions [Opens in a new window]

Abstract

We controlled the spread of epidemic methicillin-resistant Staphylococcus aureus (MRSA) infection in an 884-bed veterans' facility by cohorting known active MRSA carriers and MRSA-infected patients on one nursing unit. Simultaneously, all previously-institutionalized transfers into the veterans' facility were screened with swab cultures for MRSA at the time of admission. All MRSA patients were maintained on contact (gown and glove) or strict isolation and treated aggressively with topical and enteral antibiotics with the assistance of the infectious disease consultant. The monthly incidence of new MRSA patients dropped from a maximum of 16 per month to three or less per month within six months of instituting these infection control measures. There were no further MRSA bacteremias after the establishment of the MRSA cohort in a single unit. Aggressive cohort management of known MRSA patients and screening of previously-institutionalized patients on admission for MRSA controlled epidemic MRSA in this large institution.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 7 , July 1990 , pp. 343 - 350
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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.Colley, EW, McNicol, MW, Bracken, PM. Methicillm-resistant Staphylococci in a general hospital. Lancet. 1965;1:595–597.Google Scholar
2.Sorrel, TC, Packham, DR, Shanker, S, et al.Vancomycin therapy for methicillin-resistant Staphylococcus aureus. Ann Intern Med. 1982;97:344–350.Google Scholar
3.Cookson, BD, Philips, I. Epidemic methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 1988;2lSC:57–65.Google Scholar
4.Lane, WR. Methicillin resistance in Staphylococci. Med J Aust. 1962;49:962–965.Google Scholar
5.Thompson, RL, Wenzel, RP. Editorial: international recognition of methicillin- resistant strains of Staphylococcus aureus. Ann Intern Med. 1982;97:925–926.Google Scholar
6.Guiguet, M, Rekacewicz, C, Leclercq, B, et al.Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit. Infect Control Hosp Epidemiol. 1990;11:23–26.Google Scholar
7.Barrett, FF, McGehee, RF, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologie and epidemiologic observations. N Engl J Med. 1968;279:441–448.Google Scholar
8.Crossley, K, Loesch, D, Landesman, B, et al.An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis. 1979;139:273–279.Google Scholar
9.Boyce, JM, Landry, M, Deetz, TR, et al.Epidemiologie studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control. 1981;2:110–116.Google Scholar
10.Haley, RW, Hightower, AW, Khabbaz, RF, et al.The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Ann Intern Med 1982;97:297–308.Google Scholar
11.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med. 1982;97:309–317.Google Scholar
12.Hall, LE, Klein, EG, Slater, LN, et al.A descriptive analysis of methicillin-resistant Staphylococcus aureus in veterans. Am J lnfect Control. 1988;16:89. Abstract.Google Scholar
13.Levine, DP, Cusing, RD, Jui, J, et al.Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit Medical Center. Ann Intern Med. 1982;97:330–338.Google Scholar
14.Saravolatz, LD, Pohlod, DJ, Arking, LM. Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks. Ann Intern Med. 1982;97:325–329.Google Scholar
15.Storch, GA, Radcliff, JL, Meyer, PL, et al.Methicillin-resistant Staphylococcus aureus in a nursing home. Infect Control. 1987;8:24–29.Google Scholar
16.Cederna, JE, Terpenning, MS, Ensberg, M, et al. Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin. Infect Control Hasp Epidemiol. 1990;11:13–16.Google Scholar
17.McGowan, JE. Gram-positive bacteria: spread and antimicrobial resistance in university and community hospitals in the USA. J Antimicrob Agents Chemother. 1988;21SC:49–55.Google Scholar
18.Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hasp Epidemiol. 1988;9:255–260.Google Scholar
19.Mylotte, JM, McDermott, D, Spooner, JA. Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia. Rev Infect Dis. 1987:9:891–907.Google Scholar
20.Locksley, RM, Cohen, ML, Qumn, TC, et al.Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med. 1982;97:317–324.Google Scholar
21.Aldridge, KE. Methicillin-resistant Staphylococcus: clinical and laboratory features. Infect Control. 1985;6:461–465.Google Scholar
22.Kristinsson, KG, Fenton, P, Norman, P. Control of epidemic methicillin-resistant Staphylococcus aureus. Lancet 1987;1:274–275.Google Scholar
23.Roccaforte, JS, Bittner, MJ, Stumpt, CA, et al.Attempts to eradicate methicillin-resistant Staphylococcus aureus colonization with the use of trimethoprim-sulfamethoxazole, rifampin, and bacitracin. Am J Infect Control. 1988;16:141–146.Google Scholar
24.Tufnell, D, Croton, RS, Hemingway, DM, et al.Methicillin-resistant Staphylococcus aureus; the role of antisepsis in the control of an outbreak. J Hosp Infect. 1987;10:255–259.Google Scholar
25.Walsh, TJ, Vlahov, D, Hansen, SL, et al.Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylo-coccus aureus. Infect Control. 1987;8:7–14.Google Scholar
26.Thornsberry, C, McDougal, LK. Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heteroresistant) Staphylococci. J Clin Microbial. 1983;18:1084–1091.Google Scholar
27.Brumfitt, W, Hamilton-Miller, J. Methicillin-resistant Staphylococcus aureus. N Engl J Med. 1989;320:1188–1196.Google Scholar
28.Chambers, HF. Methicillin-resistant Staphylococci. Clin Microbial Rev. 1988;1:173–186.Google Scholar
29.Longfield, JN, Townsend, TR, Cruess, DF, et al.Methicillin-resistant Staphylococcus aureus (MRSA): risk and outcome of colonized vs infected patients. Infect Control. 1985;6:445–450.Google Scholar
30.Ribner, BS, Landry, MN, Gholson, GL. Strict versus modified isolation for prevention of nosocomial transmission of methicillin-resistant Staphylococcus aureus. Infect Control. 1986;7:317–320.Google Scholar
31.Lynch, P, Jackson, MM, Cummings, MJ, et al.Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med. 1987;107:243–246.Google Scholar
32.Zinner, SH, Lagast, H, Klastersky, J. Antistaphylococcal activity of rifampin and other antibiotics. J Infect Dis, 1981;144:365–371.Google Scholar
33.Watanakunakorn, C. Treatment of infections due to methicillin-resistant Staphylococcus aureus. Ann Intern Med. 1982;97:376–378.Google Scholar
34.Kerr, HD, Byrd, JC. Community hospital transfers to a VA Medical Center. JAMA. 1989;262:70–73.Google Scholar
35.Bartzokas, CA, Paton, JH, Gibson, MR, et al.Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med. 1984;311:1422–1425.Google Scholar
36.Hartman, B, Tomasz, A. Altered penicillin-binding proteins in methicillin-resistant strains of Staphylococcus aureus. Antimicrob Agents Chemother. 1981;19:726–735.Google Scholar
37.Sabath, LD. Mechanisms of resistance to b-lactam antibiotics in strains of Staphylococcus aureus. Ann Intern Med. 1982;97:339–344.Google Scholar
38.Kayser, FH. Mechanisms of methicillin resistance in Staphylococci. Challenges in gram-positive infection. Microbiology Perspective. 1988;1:20–23.Google Scholar
39.Bitar, CM, Mayhall, CG, Lamb, VA, et al.Outbreak due to methicillm-and rifampin-resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control. 1987;8:15–23.Google Scholar
40.Kristinsson, KG, Fenton, P, Norman, P. Control of epidemic methicillin-resistant Staphylococcus aureus. Lancet. 1987;1:274–275.Google Scholar
41.Cookson, B, Talsania, H, Naidoo, J, et al.Strategies for typing and properties of epidemic methicillin-resistant Staphylococcus aureus. Eur J Clin Microbial Infect Dis. 1986;5:702–709.Google Scholar
42.Khalifa, IK, Heiban, AA, Hancock, G. Nontypeable bacteriophage patterns of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbial. 1989;27:2249–2251.Google Scholar
43.Mulligan, ME, Kwok, RYY, Citron, DM, et al.Immunoblots, antimicrobial resistance, and bacteriophage typing of oxacillin-resistant Staphylococcus aureus. J Clin Microbial. 1988;26:2395–2401.Google Scholar