Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-24T05:28:08.663Z Has data issue: false hasContentIssue false
  • English
  • Français

Observations Relating to an Inter-Hospital Outbreak of Methicillin-Resistant Staphylococcus aureus: Role of Antimicrobial Therapy in Infection Control

Published online by Cambridge University Press:  02 January 2015

Thomas T. Ward ,
Rick E. Winn ,
Alan I. Hartstein  and
David L. Sewell
Thomas T. Ward*
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
Rick E. Winn
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
Alan I. Hartstein
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
David L. Sewell
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
*
Infectious Disease Section, Department of Medicine, Portland VA Medical Center, Portland, Oregon 97201
Get access Rights & Permissions [Opens in a new window]

Abstract

Clinical, bacteriologie, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p < 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p < 0.01), but, in contrast to previous studies, this was not a significant risk factor (p > 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p < 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus. [Infect Control 1981; 2(6):453-459.]

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 2 , Issue 6 , December 1981 , pp. 453 - 459
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1981

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.Barrett, FF, McGehee, RJ, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital. Bacteriologie and epidemiologic observations. N Engl J Med 1968; 279:441–448.Google Scholar
2.O'Toole, RD, Drew, L, Dahlgren, BJet al.An outbreak of methicillin-resistant Staphylococcus aureus infection. JAMA 1970; 213:257–263.Google Scholar
3.Klimek, JJ, Maraik, DJ, Bartlett, RCet al.Clinical, epidemiologic and bacteriologie observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Amer J Med 1976; 61:340–344.Google Scholar
4.Evertt, ED, Rahm, AE, Nitt, MSet al.Epidemiologic investigation of methicillin-resistant Staphylococcus aureus in a burn unit. Milit Med 1978; 143:165–167.Google Scholar
5.Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. J Infect Dis 1979; 139:280–287.Google Scholar
6.Sieger, BE, Long, JM, Lindberg, RB. Methicillin-resistant staphylococci in thermally injured patients: Clinical aspects. 15th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, D.C., Abstract #152, 1975.Google Scholar
7.Nicholas, P, Pringle, G, Malnvany, M. Hospital infections caused by methicillin-resistant Staphylococcus aureus: Clinical and bacteriologie aspects. 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Ill, Abstract #144, 1976.Google Scholar
8.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
9.Survey of infection control programs to be undertaken. Hospitals 1975: 49(9):71.Google Scholar
10.Anderson, TW. An introduction to Multivariate Statistical Analysis. New York, Wiley, 1958, p 374.Google Scholar
11.Bauer, AW, Kirby, WMM, Sherris, JC. Antibiotic susceptibility testing by a standardized single dose method. Amer J Clin Path 1966; 45:493–496.Google Scholar
12.Steers, E, Foltz, EL, Graves, BS. An inocula replicating apparatus for routine testing of bacterial susceptibility to antibiotics. Antibiot Chemother 1959; 9:307–311.Google Scholar
13.Baird-Parker, AC. A classification of micrococci and staphylococci based on physiologic and biochemical tests. J Gen Microbiol 1963; 30:409–427.CrossRefGoogle ScholarPubMed
14.Richmond, AS, Simberkoff, MS, Schafler, Set al.Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin. J Infect Dis 1977; 135:108–112.CrossRefGoogle ScholarPubMed
15.Fekerty, FR. The epidemiology and prevention of staphylococcal infection. Medicine 1964; 43:593–613.Google Scholar
16.Musher, DM, McKenzie, SO. Infection due to Staphylococcus aureus. Medicine 1977; 56:383–409.Google Scholar
17.Kunin, CM, Brandt, D, Wood, H. Bacteriologie studies of rifampin, a new semi-synthetic antibiotic. J Infect Dis 1969; 118:132–137.Google Scholar
18.Mandeli, GL, Vest, TK. Killing of intraleukocytic Staphylococcus aureus by rifampin: In vitro and in vivo studies. J Infect Dis 1972; 125:486–490.Google Scholar
19.Sande, MA, Mandeli, GL. Effect of rifampin on nasal carriage of Staphylococcus aureus. Antimicrob Agents Chemother 1975; 7:294–297.Google Scholar
20.Brickner, PW. Rifampin: Clinical studies with a new antibiotic. J Clin Pharmacol 1969; 9:243–250.Google Scholar
21.Bryan, CS, Wilson, RS, Meade, Pet al.Topical antibiotic ointment for staphylococcal nasal carriers: Survey of current practices and comparison of bacitracin and vancomycin ointments. Infect Control 1980; 1:153–156.Google Scholar
22.White, AC. Relationship between quantitative nasal cultures and dissemination of staphylococci. J Lab Clin Med 1961; 58:273–277.Google Scholar
23.Goldstein, BP, Ripamonti, F, Bolzoni, Get al.Rifampin plus trimethoprim bactericidal activity and suppression of resistance in human urine in vitro. Antimicrob Agents Chemother 1979; 16:736–742.Google Scholar
24.Norden, CW, Keleti, E. Treatent of experimental staphylococcal osteomyelitis with rifampin and trimethoprim, alone and in combination. Antimicrob Agents Chemother 1980; 17:591–594.Google Scholar
25.Mandeli, GL, Morman, DR. Treatment of experimental staphylococcal infections: Effect of rifampin alone and in combination on development of rifampin resistance. Antimicrob Agents Chemother 1980; 17:658–662.Google Scholar