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Should We Vigorously Try to Contain and Control Methicillin-Resistant Staphylococcus aureus?

Published online by Cambridge University Press:  21 June 2016

John M. Boyce*
Affiliation:
Department of Medicine, Miriam Hospital and Brown University, Providence, Rhode Island
*
The Miriam Hospital, 164 Summit Ave., Providence, RI 02906

Abstract

Objective:

To review practices currently used to control transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, determine the frequency of their use, and discuss the indications for implementing such measures.

Design:

A questionnaire survey to determine how commonly selected control practices are used, and a literature review of the efficacy of control practices.

Participants:

Two hundred fifty-six of 360 hospital-based members fo the Society for Hospital Epidemiology of America, Inc. (SHEA) completed the survey questionnaire.

Result:

Many different combinations of surveillance and control measures are used by hospitals with MRSA. Nine percent of hospitals stated that no special measures were used to control MRSA. The efficacy of commonly used control measures has not been established by controlled trials.

Conclusions:

Implementing control measures is warranted when MRSA causes a high incidence of serious nosocomial infections, and is desirable when MRSA has been newly introduced into a hospital or into an intensive care unit, or when MRSA accounts for more than 10% of nosocomial staphylococcal isolates. While the value of some practices is well established, measures such as routinely attempting to eradicate carriage of MRSA by colonized patients and personnel require further evaluation.

Type
Original articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Boyce, JM, Causey, WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control. 1982;3:377383.CrossRefGoogle ScholarPubMed
2. Haley, RW, Hightower, AW, Khabbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Possible role of the house staff-patient transfer circuit. Ann Intern Med. 1982;97:297308.CrossRefGoogle ScholarPubMed
3. Jarvis, WR, Thornsberry, C, Boyce, J, Hughes, JM. Methicillin-resistant Staphylococcus aureus at children's hospitals in the United States. Pediatr Infect Dis.1985;4:651655.CrossRefGoogle ScholarPubMed
4. Preheim, LC. Rimland, D. Bittner, MT. Methicillin-resistant Staphylococcus aureus in Veterans Administration Medical Centers. Infect Control. 1987;8:191194.CrossRefGoogle ScholarPubMed
5. Wakefield, DS, Pfaller, M, Massanari, RM, Hammons, GT Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control. 1987;8:151157.CrossRefGoogle ScholarPubMed
6. Hughes, JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy. 1988;34:553561.10.1159/000238624CrossRefGoogle Scholar
7. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol. 1990;11:639642.CrossRefGoogle ScholarPubMed
8. McDougal, LK, Thornsberry, C. The role of Β-tactamase in staphylococcal resistance to penicillinase-resistant penicillins and cephalosporins. J Clin Microbiol. 1986;23:832839.10.1128/jcm.23.5.832-839.1986CrossRefGoogle ScholarPubMed
9. Thornsberry, C, McDougal, LK. Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heter-oresistant) staphylococci. J Clin Microbiol. 1983;18:10841091.CrossRefGoogle Scholar
10. Jorgensen, JH, Redding, JS, Maher, LA Ramirez, PE. Salt-supplemented medium for testing methicillin-resistant staphylococci with newer Β-lactams. J Clin Microbiol. 1988;26:16751678.CrossRefGoogle ScholarPubMed
11. 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.CrossRefGoogle ScholarPubMed
12. Mulligan, ME, Kwok, RY, Citron, DM, John, JF Jr, Smith, PB. Immunoblots, antimicrobial resistance, and bacteriophage typing of oxacillin-resistant Staphylococcus aureus . J Clin Microbiol. 1988;26:23952401.CrossRefGoogle ScholarPubMed
13. Jordens, JZ, Hall, LM. Characterisation of methicillin-resistant Staphylococcus aureus isolates by restriction endonuclease digestion of chromosomal DNA. J Med Microbiol.1988;27:117123.10.1099/00222615-27-2-117CrossRefGoogle ScholarPubMed
14. Bigelow, N, Ng, LK, Robson, HG, Dillon, JR. Strategies for molecular characterisation of methicillin- and gentamicin-resistant Staphylococcus aureus in a Canadian nosocomial outbreak. J Med Microbiol. 1989;30:5158.10.1099/00222615-30-1-51CrossRefGoogle Scholar
15. Burnie, JP, Matthews, RC, Lee, W, Murdoch, D. A comparison of immunoblot and DNA restriction patterns in characterising methicillin-resistant isolates of Staphylococcus aureus . J Med Microbiol 1989;29:255261.CrossRefGoogle ScholarPubMed
16. Chambers, HR Methicillin-resistant staphylococci. Clin Microbiol Rev.1988:1:173186.CrossRefGoogle ScholarPubMed
17. Watanakunakorn, C. Treatment of infections due to methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:376378.CrossRefGoogle ScholarPubMed
18. Sorrell, TC, Packham, DR, Shanker, S, Foldes, M, Munro, R. Vancomycin therapy for methicillin-resistant Staphylococcus aureus . Ann Intern Med.1982;97:344350.10.7326/0003-4819-97-3-344CrossRefGoogle ScholarPubMed
19. Marples, RR, Cooke, EM. Current problems with methicillin-resistant Staphylococcus aureus . J Hosp Infect. 1988;11:381392.CrossRefGoogle ScholarPubMed
20. Guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus. Report of a combined working party of the Hospital Infection Society and British Society for Antimicrobial Chemotherapy. J Hosp Infect.1986;7:193201.CrossRefGoogle Scholar
21. Bell, SM. Recommendations for control of the spread of methicillin-resistant Staphylococcus aureus infection based on 18 years' experience in a group of teaching hospitals. Med J Aust.1982;1:472474.CrossRefGoogle Scholar
22. McManus, AT, Mason, AD Jr, McManus, WF, Pruitt, BA Jr. What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? Arch Surg.1989;124:14561459.CrossRefGoogle Scholar
23. Lacey, RW. Multi-resistant Staphylococcus aureus-a suitable case for inactivity.J Hosp Infect.1987;9:103105.CrossRefGoogle ScholarPubMed
24. Cookson, BD, Phillips, I. Epidemic methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 1988;21 (suppl C):5765.CrossRefGoogle ScholarPubMed
25. Marples, RR, Richardson, JF, DeSaxe, MJ. Bacteriological characters of strains of Staphylococcus aureus submitted to a reference laboratory related to methicillin resistance journal of Hygiene. 1986;96:217223.10.1017/S0022172400065980CrossRefGoogle ScholarPubMed
26. Bitar, CM, Mayhall, CG, Lamb, VA, Bradshaw, TJ, Spadora, AC, Dalton , HP. Outbreak due to methicillin-and rifampin-resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control. 1987;8:1523.CrossRefGoogle ScholarPubMed
27. Alvarez, S, Shell, C, Gage, K, et al.An outbreak of methicillin-resistant Staphylococcus aureus eradicated from a large teaching hospital. Am J Infect Control. 1985;13:115121.CrossRefGoogle ScholarPubMed
28. Boyce, JM, Landry, M, Deetz, TR, DuPont, HL. Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control.1981;2:110116.CrossRefGoogle ScholarPubMed
29. Peacock, JE Jr, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med. 1980;93:526532.CrossRefGoogle Scholar
30. Thomoson, RL. Cabezudo, L, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:309317.CrossRefGoogle Scholar
31. Klimek, JJ, Marsik, FJ, Bartlett, RC, Weir, B, Shea, P, Quintiliani, R. Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med. 1976;61:340345.CrossRefGoogle Scholar
32. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med. 1981;71:5358.10.1016/0002-9343(81)90258-8CrossRefGoogle ScholarPubMed
33. 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.CrossRefGoogle ScholarPubMed
34. Millar, MR, Keyworth, N, Lincoln, C, King, B, Congdon, P. 'Methicillin-resistant' Staphylococcus aureus in a regional neonatology unit. J Hosp Infect. 1987;10:187197.CrossRefGoogle Scholar
35. Davies, EA, Emmerson, AM, Hogg, GM, Patterson, MF, Shields, MD. An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control. J Hosp Infect. 1987;10:120128.10.1016/0195-6701(87)90137-XCrossRefGoogle Scholar
36. Hill, SF, Ferguson, D. Multiply-resistant Staphylococcus aureus (bacteriophage type 90) in a special care baby unit. J Hosp Infect.1984;5:5662.CrossRefGoogle Scholar
37. Price, EH, Brain, A, Dickson, JA. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect. 1980;1:221228.CrossRefGoogle Scholar
38. Dunkle, LM, Naqvi, SH, McCallum, R, Lofgren, JP. Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensive care nursery. Am J Med. 1981:70:455458.10.1016/0002-9343(81)90787-7CrossRefGoogle Scholar
39. Lejeune, B, Buzit-Losquin, F, Simitzis-Le Flohic, AM, Le Bras, MP, Alix, D. Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children. J Hosp Infect. 1986;7:2125.CrossRefGoogle Scholar
40. Reboli, AC, John, JF Jr, Levkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child. 1989;143:3439.Google Scholar
41. Boyce, JM, White, RL, Causey, WA, Lockwood, WR. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA. 1983;249:28032807.CrossRefGoogle ScholarPubMed
42. Arnow, PM. Allyn, PA, Nichols, EM, Hill, DL, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing.J Trauma.1982;22:954959.CrossRefGoogle Scholar
43. Linnemann, CC Jr. Mason, M. Moore, P. Korfhagen, TR. Staneck, JL. Methicillin-resistant Staphylococcus aureus: experience in a general hospital over four years. Am J Epidemiol. 1982;115:941950.CrossRefGoogle Scholar
44. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II Eoidemioloeic studies. I Infect Dis. 1979;139:280287.CrossRefGoogle ScholarPubMed
45. Walsh, TJ, Vlahov, D, Hansen, SL, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus . Infect Control. 1987;8:714.CrossRefGoogle ScholarPubMed
46. Onesko, KM, Wienke, EC. The analysis of the impact of a mild, low-iodine lotion soap on the reduction of nosocomial methicillin-resistant Staphylococcus aureus: a new opportunity for surveillance by objectives. Infect Control.1987;8:284288.CrossRefGoogle Scholar
47. Bacon, AE., Iornensen, KA. Wilson, KH. Kauffman, CA. Emergence of nosocomial methicillin-resistant Staphylococcus aureus and therapy of colonized personnel during a hospital-wide outbreak. Infect Control. 1987;8:145150.CrossRefGoogle ScholarPubMed
48. Rhinehart, E, Shlaes, DM, Keys, TF, et al. Nosocomial clonal dissemination of methicillin-resistant Staphylococcus aureus. Elucidation by plasmid analysis. Arch Intern Med. 1987;147:521524.CrossRefGoogle ScholarPubMed
49. Ribner, BS, Landry, MN, Gholson, GL. Strict versus modified isolation for prevention of nosocomial transmission of methicillin-resistant Staphylococcus aureus . Infect Control. 1986;7:317320.CrossRefGoogle ScholarPubMed
50. Rimland, D. Nosocomial infections with methicillin and tobramycin resistant Staphylococcus aureus-implication of physiotherany in hospital-wide dissemination. Am I Med Sci.1985;290:9197.10.1097/00000441-198509000-00002CrossRefGoogle ScholarPubMed
51. Bradley, JM, Noone, P, Townsend, DE, Grubb, WB. Methicillin-resistant Staphylococcus aureus in a London hospital. Lancet.1985;1:1493–1495.Google Scholar
52. Pearman, JW, Christiansen, KJ, Annear, DI, et al. Control of methicillin-resistant Staphylococcus aureus (MRSA) in an Aus-tralian metropolitan teaching hospital complex. Med J Aust. 1985;142:103108.CrossRefGoogle Scholar
53. Shanson, DC, Johnstone, D,Midgley, J. Control of a hospital outbreak of methicillin-resistant Staphylococcus aureus infections: value of an isolation unit. J Hosp Infect.1985;6:285292.CrossRefGoogle ScholarPubMed
54. Tyzack, R. The management of methicillin-resistant Staphylococcus aureus in a major hospital. J Hosp Infect, 1985;6:195199.CrossRefGoogle Scholar
55. Bartzokas, CA, Paton, JFF, Gibson, MP, Graham, F, McLoughlin, GA, Croton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med. 1984;311:14221425.CrossRefGoogle ScholarPubMed
56. Ellison, RT III, Judson, FN, Peterson, LC, Cohn, DL, Ehret, JM. Oral rifampin and trimethoprim/sulfamethoxazole therapy in asymptomatic carriers of methicillin-resistant Staphylococcus aureus infections. West /Med. 1984;140:735740.Google ScholarPubMed
57. Selkon, IB. Stokes, ER. Ingham, HR. The role of an isolation unit in the control of hospital infection with methicillin-resistant staphylococci . J Hosp Infect. 1980;1:4146.CrossRefGoogle ScholarPubMed
58. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control. 1981;2:453459.CrossRefGoogle Scholar
59. 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.CrossRefGoogle ScholarPubMed
60. Pavillard, R, Harvey, K, Douglas, D, et al. Epidemic of hospital acquired infection–; due to methicillin-resistant Staphylococcus aureus in major Victorian hospitals. Med J Aust. 1982:1:451454.10.5694/j.1326-5377.1982.tb132413.xCrossRefGoogle ScholarPubMed
61. Shanson, DC, Kensit, JC, Duke, R. Outbreak of hospital infection with a strain of Staphylococcus aureus resistant to gentamicin and methicillin. Lancet. 1976;2:13471348.CrossRefGoogle ScholarPubMed
62. Michel, MF, Priem, CC. Control at hospital level of infections by methicillin-resistant staphylococci in children, journal of Hygiene. 1971;69:453460.CrossRefGoogle ScholarPubMed
63. Drew, WL, Dahlgren, BJ, Beaty, HN. An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA. 1970;213:257262.Google Scholar
64. Hill, RL, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother. 1988;22:377384.10.1093/jac/22.3.377CrossRefGoogle ScholarPubMed
65. Law, MR, Gill, ON, Turner, A. Methicillin-resistant Staphylococcus aureus: associated morbidity and effectiveness of control measures. Epidemiol Infect. 1988;101:301309.10.1017/S0950268800054224CrossRefGoogle ScholarPubMed
66. Coovadia, YM, Bhana, RH, Johnson, AP, Haffejee, I, Marples, RR. A laboratory-confirmed outbreak of rifampicin-methicillin-resistant Staphylococcus aureus (RMRSA) in a newborn nursery. J Hosp Infect. 1989;14:303312.CrossRefGoogle Scholar
67. Dacre, J, Emmerson, AM, Jenner, EA. Gentamicin-methicillin-resistant Staphylococcus aureus: epidemiology and containment of an outbreak, J Hosp Infect. 1986;7:130136.CrossRefGoogle ScholarPubMed
68. Duckworth, GJ, Lothian, JLE, Williams, JD. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London hospital. J Hosp Infect.1988;11:115.CrossRefGoogle Scholar
69. Murray-Leisure, KA, Geib, S, Graceley, D, et al. Control of epidemic methicillin-resistant Staphylococcus aureus .Infect Control Hosp Epidemiol. 1990;11:343350.CrossRefGoogle ScholarPubMed
70. Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol. 1988;9:255260.CrossRefGoogle Scholar
71. Tuffnell, DJ, Croton, RS, Hemingway, DM, Hartley, MN, Wake, PN, Garvey, RJP. Methicillin resistant Staphylococcus aureus; the role of antisepsis in the control of an outbreak. J Hosp Infect. 1987;10:255259.CrossRefGoogle ScholarPubMed
72. Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis. 1979;139:273279.CrossRefGoogle ScholarPubMed
73. Lewis, E, Saravolatz, LD. Comparison of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. Am J Infect Control. 1985;13:109114.CrossRefGoogle ScholarPubMed
74. Mehtar, S, Drabu, YJ, Mayet, F. Expenses incurred during a five-week epidemic methicillin-resistant Staphylococcus aureus outbreak. J Hosp Infect. 1989;13:199203.10.1016/0195-6701(89)90028-5CrossRefGoogle Scholar
75. Mulligan, ME, Ruane, PJ, Johnston, L, et al. Ciprofloxacin for eradication of methicillin-resistant Staphylococcus aureus colonization. Am J Med. 1987:82(suppl 4A):215219.Google ScholarPubMed
76. Blumberg, HM, Rimland, D, Wachsmuth, IK. Rapid development of ciprofloxacin resistance in methicillin-sensitive and methicillin-resistant S aureus. The 29th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 18, 1989; Houston, TX: Abstract 7.Google Scholar
77. Peterson, L, Quick, J, Jensen, B, et al. Emergence of ciprofloxacin resistance in nosocomial methicillin-resistant Staphylococcus aureus (MRSA) isolates during ciprofloxacin plus rifampin therapy for MRSA colonization. The 29th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 20, 1989; Houston, TX: Abstract 1255.Google Scholar
78. Cafferkey, MT, Hone, R, Keane, CT Sources and outcome for methicillin-resistant Staphylococcus aureus bacteremia. J Hosp Infect. 1988;11:136143.CrossRefGoogle Scholar
79. Boyce, JM. Nosocomial staphylococcal infections. Ann Intern Med. 1981;95:241242.CrossRefGoogle ScholarPubMed
80. Casewell, MW. Epidemiology and control of the 'modern' methicillin-resistant Staphylococcus aureus . J Hosp Infect. 1986;7:111.CrossRefGoogle ScholarPubMed
81. Sahm, DF, Kissinger, J, Gilmore, MS, et al. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis . Antimicrob Agents Chemother. 1989;33:15881591.CrossRefGoogle ScholarPubMed
82. Nicas, Tl, Cole, CT, Preston, DA, Schabel, AA, Nagarajan, R. Activity of glycopeptides against vancomycin-resistant gram-positive bacteria. Antimicrob Agents Chemother. 1989;33:14771481.10.1128/AAC.33.9.1477CrossRefGoogle ScholarPubMed
83. Bingen, E, Lambert-Zechovsky, N, Mariani-Kurkdjian, P, JP, Cezard, Navarro, J. Bacteremia caused by a vancomycin-resistant Enterococcus . Pediatr Infect Dis J. 1989;8:475476.CrossRefGoogle ScholarPubMed
84. Leclercq, R, Derlot, E, Weber, M, Duval, J, Courvalin, P. Transferrable vancomycin and teicoplanin resistance in Enterococcus faecium. Antimicrob Agents Chemother. 1989;33:1015.CrossRefGoogle Scholar
85. Ruoff, KL, Kuritzkes, DR, Wolfson, JS, Ferraro, MJ. Vancomycin-resistant gram-positive bacteria isolated from human sources. J Clin Microbiol. 1988;26:20642068.CrossRefGoogle ScholarPubMed
86. Kaplan, AH, Gilligan, PH, Facklam, RR. Recovery of resistant enterococci during vancomycin prophylaxis. J Clin Microbiol. 1988;26:12161218.CrossRefGoogle ScholarPubMed
87. Uttley, AH, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet.1988;1:5758.CrossRefGoogle ScholarPubMed
88. Duckworth, GJ, Lothian, JL, Williams, JD. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect. 1988;11:115.CrossRefGoogle Scholar
89. Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus . J Clin Microbiol. 1989;27:14711476.CrossRefGoogle ScholarPubMed
90. Shanson, DC. McSwiggan, DA. Operating theatre acquired infection with a gentamicin-resistant strain of Staphylococcus aureus: outbreak in two hospitals attributable to one surgeon. J Hosp Infect. 1980;1:171172.CrossRefGoogle Scholar
91. Spicer, WJ. Three strategies in the control of staphylococci including methicillin-resistant Staphylococcus aureus . J Hosp Infect. 1984;5:4549.CrossRefGoogle ScholarPubMed
92. Rahman, M, Noble, WC, Cookson, B. Mupirocin-resistant Staphylococcus aureus . Lancet. 1987;2:387.CrossRefGoogle Scholar
93. Smith, GE, Kennedy, CTC. Staphylococcus aureus resistant to mupirocin. J Antimicrob Chemother.1988;21:14142.CrossRefGoogle ScholarPubMed
94. Casewell, MW, Hill, RL. The carrier state: methicillin-resistant Staphylococcus aureus . J Antimicrob Chemother. 1986;18:112.CrossRefGoogle ScholarPubMed
95. Fekety, R. The management of the carrier of methicillin-resistant Staphylococcus aureus . Curr Clin Top Infect Dis.1987;8:169180.Google ScholarPubMed