A methicillin-resistant strain of Staphylococcus aureus (MRSA, phage type 84/85) was introduced into City of Memphis Hospital by a burn patient who had recently been treated for MRSA bacteremia in another institution 500 miles distant. Despite prompt recognition of the problem and institution of isolation procedures, six other patients developed secondary colonization during the ensuing six months, and five of these experienced clinically significant infections with MRSA. Three of the patients originally infected with MRSA, as well as two additional patients, subsequently developed colonization with staphylococcal strains of phage type 84/85 that were resistant to both methicillin and gentamicin (MRGRSA). Spread of the staphylococcal strains was most likely accomplished primarily via passive transfer from person to person. The hydrotherapy unit, which became contaminated with both MRSA and MRGRSA, may have played a secondary role. As illustrated by this outbreak, patients carrying potentially dangerous bacterial strains should be identified and informed of the problems posed by such carriage. It may be imprudent to admit such patients to hospitals that are free of the potential pathogen.

The outbreak described here exemplifies a number of potential problems associated with control of nosocomial staphylococcal infections: (a) interhospital spread of methicillin-resistant strains; (b) secondary patient-to-patient intrahospital spread; and (c) emergence of even more resistant strains, possibly associated with selective pressures exerted by widespread use of broad-spectrum antimicrobial agents.

The sporicidal activities and shelf life stabilities of three alkaline glutaraldehyde-containing sterilizing solutions were evaluated. The time required to reduce a population of spores by one log is the D-value. The test methods employed were the D-value and survival rates. Sporicidin, a new preparation containing a phenolic buffer, was both more stable and more active against test spores than two other test agents, Cidex and Cidex-7.

The incidence of infections among patients undergoing renal transplantation has been reported as high as 83% during the first post-transplant year. In an effort to reduce the occurrence of such infections, we evaluated the role of perioperative prophylactic antibiotics in these patients. Thirty-seven patients undergoing transplantation were assigned randomly to treatment groups (N=20, cefamandole, 1 gm IM every 6 hrs for 8 doses/tobramycin 1 mg/kg IM for 1 dose, starting 2 hrs prior to surgery) and control groups (N=17, no antibiotics). A uniform infection surveillance system was used. Eighty-one percent (30/37) of patients became infected; 70% (14/20) of treated patients and 94% (16/17) of controls (p=0.14). Since antibiotic prophylaxis might be expected to exert the greatest influence in the immediate postoperative period, we examined patient outcome data for both the first seven post-transplant days and for the entire hospitalization. Of the 38% (14/37) of patients who developed infections during the first posttransplant week, a statistically greater proportion came from the control group than from the treated group (10/17 vs. 4/20, p=0.04). These data suggest that this regimen is effective in reducing the occurrence of infections during the first week following renal transplantation.

Between July 2 and July 16, 1979, three patients were reported to have gram-positive cocci as seen on Gram stain of excised, macerated heart valve tissue. No organisms were isolated in culture; however, our usual procedure for handling such valves is not adequate for isolation of strict anaerobes. The first patient was treated for presumed endocarditis; this resulted in three additional weeks of hospitalization.

Review of the remaining 34 patients who had heart valve replacement surgery between February 1 and July 20, 1979 revealed three additional cases.

Careful analysis revealed that nonviable, gram-positive cocci present in commercially prepared trypticase soy broth were being added to the tissue just prior to mortar and pestle grinding in the microbiology laboratory. The contaminated tubes were noted to have a visible sediment when carefully examined.

The procedure for handling the broth has been revised; a simple screening procedure is used now to identify potentially contaminated broth. No further instances of false positive results on Gram-staining of heart value tissue have occurred since this screening procedure was introduced.