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Outbreak Due to Methicillin- and Rifampin- Resistant Staphylococcus aureus: Epidemiology and Eradication of the Resistant Strain from the Hospital

  • Cynthia M. Bitar (a1), C. Glen Mayhall (a1), V. Archer Lamb (a1), Thomas J. Bradshaw (a1), Alice C. Spadora (a1) and Harry P. Dalton (a1)...


A methicillin- and rifampin-resistant strain of Staphylococcus aureus was introduced into a university hospital by interstate transfer of an infected surgical patient. An outbreak occurred, and 17 patients became infected or colonized with the epidemic strain. Reservoirs appeared to be patients who were infected or colonized with the resistant S aureus and possibly two nurses who were nasal carriers. The outbreak isolate was likely spread by contact with contaminated hands of personnel. A retrospective case-control study identified tracheostomy, debridement, and irrigation of wounds by power spray and prolonged nasogastric intubation as risk factors for acquisition of the epidemic strain. Analysis of factors by groups indicated that surgical procedures, wound care procedures and instrumentation of the respiratory tract were significantly associated with cases. The nasal carrier state was eradicated in two nurses by topical application of 5% vancomycin. The epidemic strain was eradicated from the hospital 8 months after it was introduced.


Corresponding author

Hospital Epidemiology Unit, Division of Infectious Diseases, MCV Station, Box 19, Richmond, VA 23298-0001


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1.Jevons, MP: “Celbenin”-resistant staphylococci. Br Med J 1961; 1:124125.
2.Barrett, FF, McGehee, RF Jr, Finland, M: Methicillin-resistant Staphylococcus aureus at Boston City Hospital. Bacteriologie and epidemiologic observations. N Engl J Med 1968; 279:441448.
3.Richmond, AS, Simberkoff, MS, Schaefler, S, et al: Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin. J Infect Dis 1977; 135:108112.
4.Everett, ED, Rahm, AE Jr, McNitt, TR, et al: Epidemiologic investigation of methicillin-resistant Staphylococcus aureus in a burn unit. Milit Med 1978; 143:165167.
5.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; 139:273279.
6.Crossley, K, Landesman, B, Zaske, D: An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979; 139:280287.
7.Peacock, JE, Marsik, FJ, Wenzel, RP: Methicillin-resistant Staphylococcus aureus: Introduction and spread within a hospital. Ann Intern Med 1980; 93:526532.
8.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; 1:221228.
9.Saroglou, G, Cromer, M, Bisno, AL: Methicillin-resistant Staphylococcus aureus: Interstate spread of nosocomial infections with emergence of gentamicin-methicillin-resistant strains. Infect Control 1980; 1:8189.
10.Ward, TT, Winn, RE, Hartstein, AI, et al: Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: Role of antimicrobial therapy in infection control. Infect Control 1981; 2:453459.
11.McDonald, M, Hurse, A, Sim, KN: Methicillin-resistant Staphylococcus aureus bacteremia. Med J Aust 1981; 2:191194.
12.Dunkle, LM, Naqvi, SH, McCallum, R, et al: Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensive care nursery. Am J Med 1981; 70:455458.
13.Craven, DE, Reed, C, Kollisch, N, et al: A large outbreak of infections caused by a strain ofStaphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med 1981; 71:5358.
14.Boyce, JM, Landry, M, Deetz, TR, et al: Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981; 2:110116.
15.Bock, BV, Pasiecznik, K, Meyer, RD: Clinical and laboratory studies of nosocomial Staphylococcus aureus resistant to methicillin and aminoglycosides. Infect Control 1982; 3:224229.
16.Myers, JP, Linnemann, CC Jr: Bacteremia due to methicillin-resistant Staphylococcus aureus. J Infect Dis 1982; 145:532536.
17.Maki, DG, Wise, CE, Sarafin, HW: A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977; 296:13051309.
18.National Committee on Clinical Laboratory Standards, 1980. Proposed Standard PSM-7. Standard methods for dilution antimicrobial susceptibility tests for bacteria which grow aerobically. National Committee on Clinical Laboratory Standards, Villanova, PA.
19.Archer, GL, Mayhall, CG: Comparison of epidemiological markers used in the investigation of an outbreak of methicillin-resistant Staphylococcus aureus infections. J Clin Microbiol 1983; 18:395399.
20.Locksley, RM, Cohen, ML, Quinn, TC, et al: Multiply antibiotic-resistant Staphylococcus aureus: Introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982; 97:317324.
21.Klimek, JJ, Marsik, FJ, Bartlett, RC, et al: Clinical, epidemiologic and bacteriologie observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med 1976; 61:340345.
22.Rutala, WA, Katz, EBS, Sherertz, RJ, et al: Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983; 18:683688.
23.Linnemann, CC Jr, Mason, M, Moore, P, et al: Methicillin-resistant Staphylococcus aureus: Experience in a general hospital over four years. Am J Epidemiol 1982; 115:941950.
24.Graham, DR, Correa-Villasenor, A, Anderson, RL, et al: Epidemic neonatal gentamicin-methicillin-resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin. J Pediatr 1980; 97:972978.
25.Thompson, RL, Cabezudo, I, Wenzel, RP: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97:309317.
26.Lentino, JR, Hennein, H, Krause, S, et al: A comparison of pneumonia caused by gentamicin, methicillin-resistant and gentamicin, methicillin-sensitive Staphylococcus aureus: Epidemiologic and clinical studies. Infect Control 1985; 6:267272.


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