Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-19T17:44:16.170Z Has data issue: false hasContentIssue false
  • English
  • Français

Emergence of Nosocomial Methicillin-Resistant Staphylococcus aureus and Therapy of Colonized Personnel during a Hospital-Wide Outbreak

Published online by Cambridge University Press:  02 January 2015

Alfred E. Bacon ,
Karen A. Jorgensen ,
Kenneth H. Wilson  and
Carol A. Kauffman
Alfred E. Bacon
Affiliation:
Division of Infectious Diseases, Ann Arbor Veterans Administration Medical Center andThe University of Michigan Medical School, Ann Arbor, Michigan
Karen A. Jorgensen
Affiliation:
Division of Infectious Diseases, Ann Arbor Veterans Administration Medical Center andThe University of Michigan Medical School, Ann Arbor, Michigan
Kenneth H. Wilson
Affiliation:
Division of Infectious Diseases, Ann Arbor Veterans Administration Medical Center andThe University of Michigan Medical School, Ann Arbor, Michigan
Carol A. Kauffman*
Affiliation:
Division of Infectious Diseases, Ann Arbor Veterans Administration Medical Center andThe University of Michigan Medical School, Ann Arbor, Michigan
*
Division of Infectious Diseases, Ann Arbor Veterans Administration Medical Center, Ann Arbor, MI 48105
Get access Rights & Permissions [Opens in a new window]

Abstract

At the Ann Arbor Veterans Administration Medical Center, 30 patients over a 6-month period became nosocomially infected or colonized by methicillin-resistant Staphylococcus aureus. Immediate institution of strict infection control measures, in conjunction with surveillance cultures of personnel and treatment of carriers, did not limit spread of the outbreak strain of MRSA. Multiple nonoutbreak strains, phenotypically exhibiting heteroresistance, were also uncovered. Thirteen hospital personnel were identified as MRSA carriers. Trimethoprim-sulfamethoxazole (TMP-SMX) and rifampin initially eradicated the carrier state, documented by anterior nares cultures in 13 courses of treatment in 11 employees. However, three employees were recolonized, one at one month, one at both one and four months, and one at four months. Treatment of the carrier state reservoir among personnel appeared to have no effect on the emergence and spread of nosocomial MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 8 , Issue 4 , April 1987 , pp. 145 - 150
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1987

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.Haley, RW, Hightower, AW, Khabbaz, RF, et al: The emergence of nicthicillin-resistant Staphylococcus aureus infections in United States hospitals. Ann Intern Med 1982; 97:297–308.Google Scholar
2.Grieble, HG. Krause, SL, Pappas, SA, et al: The prevalence of high level niethicillin resistance in multiply resistant hospital staphylococci. Medicine 1981; 60:62–69.Google Scholar
3.Boyce, JM, Causey, WA: Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control 1982; 3:377–383.CrossRefGoogle ScholarPubMed
4.Crossley, K, Loesch, D, Landesman, B. et al: An outbreak of infections caused by strains of Staphylococcus aureus resistant to mcthicillin and aminoglycosides. I. Clinical studies. J Infect Dis 1979; 139:273–279.Google Scholar
5.Myers, J, Linneman, CC: Bacteremia due to methicillin-resistant Staphylococcus aureus. J Infect Dis 1982; 145:532–536.Google Scholar
6.Crossley, K, Landsman, B, Zaski, D: An outbreak of infections caused by strains of Staphylococcus aureus resistant to niethicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979; 139:280–287.Google Scholar
7.Saravolatz, L, Markowiu, N. Arking, L, et al: Methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 96:11–16.Google Scholar
8.Saraglou, G, Cromer, M, Bisno, AL: Methicillin-resistaiil Staphylococcus aureus: Interstate spread of nosocomial infections with emergence of genlamicin-methicillin resistant strains. Infect Control 1980; 1:81–89.Google Scholar
9.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
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; 2:453–459.Google Scholar
11.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
12.Locksley, RM. Cohen, MC, Quinn, TC. et al: Multiply antibiotic-resistant Staphylococcus aureus: Introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982; 97:317–324.CrossRefGoogle ScholarPubMed
13.Bock, BV, Pasiecnick, K, Meyer, R: Clinical and laboratory studies of nosocomial Staphylococcus aureus resistant to niethicillin and aminoglycosides. Infect Control 1982: 3:224–229.Google Scholar
14.Thompson, RL. Cabezudo, I. Wenzel, RP: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcia aureus. Ann Intern Med 1982; 97:309–317.Google Scholar
15.Boyce, JM, White, RL, Causey, WA, et al: Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA 1983; 249:2803–2807.Google Scholar
16.Ellison, RT, judson, FN, Peterson, LC, et al: Oral rifampin and trimethoprim-sulfamethoxazole therapy in asymptomatic carriers of methicillin-resistant Staphylococcus aureus. West J Med 1984; 140:735–740.Google Scholar
17.Boyce, JM, Landry, M, Deetz, TR, et al: Epidemiologie studies of an outbreak of nosocomial methicillin-resistant Staphylococcus auretis infections. Infect Control 1981; 2:110–116.CrossRefGoogle Scholar
18.Hansen, SL, Freedy, PK: Variation in the abilities of automated, commercial and reference methods lo detect methicillin-resistant (heleroresisiant) Staphylococcus aureus. J Clin Microbiol 1984: 20:494–499.CrossRefGoogle Scholar
19.Boyce, JM. Lylle, LS, Walsh, DA: Detection of methicillin-resistant Staphylococcus aureus by microdilution and disk elution susceptibility systems. J Clin Microbiol 1984; 20:1068–1075.CrossRefGoogle ScholarPubMed
20.Harwick, H, Weiss, P. Fekety, R: Application of microtitralion techniques to bacteriostatic and bacteriocidal antibiotic susceptibility testing. J Lab Clin Med 1968:72:511.Google Scholar
21.Bartzokas, CA, Paton, JH, Gibson, MF, et al: Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med 1984; 311:1425–1427.Google Scholar
22.Onesko, K, Wienke, EC: The impact of a mild low-iodine health care personnel hand wash on nosocomial nietliicillin-resistant Staphylococcus aureus (MRSA). Am J Infect Control 1985; 13:131.Google Scholar
23.Cleary, TJ, Manor, D: Methicillin-resistant Staphylococcus aureus susceptibility testing by an automated system Autobac I. Antimicrob Agents Chemother 1978; 13:837–847.Google Scholar
24.McDougal, LK, Thornsberry, C: New recommendations for disc diffusion antimicrobial susceptibility tests for methicilliti-resisiant (heleroresistanl) staphylococci. J Clin Microbiol 1984: 19:482–488.Google Scholar