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Prospective study of infection, colonization and carriage of methicillin-resistantStaphylococcus aureus in an outbreak affecting 990 patients

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Abstract

In the three years between November 1989 and October 1992, an outbreak of methicillin-resistantStaphylococcus aureus (MRSA) affected 990 patients at a university hospital. The distribution of patients with carriage, colonization or infection was investigated prospectively. Nosocomial acquisition was confirmed in at least 928 patients, 525 of whom were identified from clinical specimens as being infected (n=418) or colonized (n=107) by MRSA. An additional 403 patients were identified from screening specimens, of whom 58 subsequently became infected and 18 colonized. Screening of the nose, throat and perineum detected 98 % of all carriers. Of the 580 infections in 476 patients, surgical wound, urinary tract and skin infections accounted for 58 % of the infections. Of the 476 infected patients, death was attributable to MRSA infection in 13 %. Colonization with MRSA was found in 127 patients and 42 % of 165 colonized sites were the skin. Auto-infection from nasal carriage or cross-infection, probably via staff hands, seemed to be the most common mode of acquisition of MRSA infections.

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References

  1. Haley RW, Hightower AW, Khabbaz RF, Thornsberry C, Martone WJ, Allen JR, Hughes JM The emergence of methicillin-resistantStaphylococcus aureus infections in United States hospitals. Annals of Internal Medicine 1982, 97: 297–308.

    PubMed  CAS  Google Scholar 

  2. Boyce JM, Causey WA Increasing occurrence of methicillin-resistantStaphylococcus aureus in the United States. Infection Control 1982, 3: 377–382.

    PubMed  CAS  Google Scholar 

  3. Casewell MW Epidemiology and control of the “modern” methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1986, 7, Supplement A: 1–11.

    Article  PubMed  Google Scholar 

  4. Pavillard R, Harvey K, Douglas D, Hewstone A, Andrew J, Collopy B, Asche V, Carson P, Davidson A, Gilbert G, Spider J, Tosoline F Epidemic of hospital-acquired infection due to methicillin resistantStaphylococcus aureus in major Victorian hospitals. Medical Journal of Australia 1982, 1: 451–454.

    PubMed  CAS  Google Scholar 

  5. Jepsen OB The demise of the old methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1986, 7, Supplement A: 13–17.

    Article  PubMed  Google Scholar 

  6. Marples RR, Cooke EM Current problems with methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1988, 11: 381–392.

    Article  PubMed  CAS  Google Scholar 

  7. Morgan MG, Harte-Barry MJ Methicillin-resistantStaphylococcus aureus: a ten year survey in a Dublin hospital. Journal of Hospital Infection 1989, 14: 357–362.

    Article  PubMed  CAS  Google Scholar 

  8. French GL, Cheng AFB, Ling JML, Mo P, Donnan S Hong Kong strains of methicillin-resistant and methicillin-sensitiveStaphylococcus aureus have similar virulence. Journal of Hospital Infection 1990, 15: 117–125.

    Article  PubMed  CAS  Google Scholar 

  9. Shanson DC, Kensit JG, Duke R Outbreak of hospital infection with a strain ofStaphylococcus aureus resistant to gentamicin and methicillin. Lancet 1976, ii: 1347–1348.

    Article  Google Scholar 

  10. Crossley K, Loesch D, Landesman B, Mead K, Chern M, Strate R An outbreak of infections caused by strains ofStaphylococcus aureus resistant to methicillin and aminoglycosides. Clinical studies. Journal of Infectious Diseases 1979, 139: 273–279.

    PubMed  CAS  Google Scholar 

  11. Crossley K, Landesman B, Zaske D An outbreak of infections caused by strains ofStaphylococcus aureus resistant to methicillin and aminoglycosides. Epidemiologic studies. Journal of Infectious Diseases 1979, 139: 280–287.

    PubMed  CAS  Google Scholar 

  12. Peacock JE Jr, Marsik FJ, Wenzel RP Methicillin-resistantStaphylococcus aureus introduction and spread within a hospital. Annals of Internal Medicine 1980, 93: 526–532.

    PubMed  Google Scholar 

  13. Thompson RL, Cabezudo I, Wenzel RP Epidemiology of nosocomial infections caused by methicillin-resistantStaphylococcus aureus. Annals of Internal Medicine 1982, 97: 309–317.

    PubMed  CAS  Google Scholar 

  14. Linnemann CC Jr, Mason M, Moore P, Korfhagen TR, Stancck JL Methicillin-resistantStaphylococcus aureus: experience in a general hospital over four years. American Journal of Epidemiology 1982, 115: 941–950.

    PubMed  Google Scholar 

  15. Duckworth GJ, Lothian JLE, Willians JD Methicillin-resistantStaphylococcus aureus: report of an outbreak in a London teaching hospital. Journal of Hospital Infection 1988, 11: 1–15.

    Article  PubMed  CAS  Google Scholar 

  16. Vandenbroucke-Grauls CM, Frénay HME, van Klingeren B, Savekoul TF, Verhoef J Control of epidemic methicillin-resistantStaphylococcus aureus in a Dutch University Hospital. European Journal of Clinical Microbiology and Infectious Diseases 1991, 10: 6–11.

    Article  CAS  Google Scholar 

  17. Pérez Trallero E, García Arenzana J, Ansa Castañeda A, Paisan Grisolia L Unusual multiresistantStaphylococcus aureus in a newborn nursery. American Journal of Diseases of Children 1981, 135: 689–692.

    PubMed  Google Scholar 

  18. Bouza E, Martinez-Beltrán J, Groupo de Trabajo para el estudio de estafilococos Estudio multicéntrico sobre la prevalencia de estafilococos en España. (Informe preliminar). Enfermedades Infecciosas y Microbiología Clínica 1988, 6: 68–79.

    Google Scholar 

  19. Rodriguez-Creixems M Evolución de la resistencia a antimicrobianos de staphylococcus aislados en hospitales españoles. Enfermedades Infecciosas y Microbiologia Clínica 1992, 10, Suplemento 3: 24–29.

    PubMed  Google Scholar 

  20. Parras F, Rodriguez M, Bouza E, Muñoz P, Cercenado E, Guerrero C, Zancada G Brote epidémico deStaphylococcus aureus resistente a meticilina (SARM) en un hospital general. Informe preliminar. Enfermedades Infecciosas y Microbiología Clínica 1991, 9: 200–207.

    PubMed  CAS  Google Scholar 

  21. Trilla A, Marco F, Moreno A, Prat A, Soriano E, Jiménez de Anta MT, Comité de Control de Infecciones Epidemilogía clínica de un brote de infección nosocomial porStaphylococcus aureus resistente a meticilina y aminoglucósidos eficacia de las medidas de control. Medicina Clínica (Barcelona) 1993, 100: 205–209.

    CAS  Google Scholar 

  22. Aparicio P, Richardson J, Martin S, Vindel A, Marples RR, Cookson BD An epidemic methicillin-resistant strain ofStaphylococcus aureus in Spain. Epidemiology of Infection 1992, 108: 287–298.

    CAS  Google Scholar 

  23. Garner JS, Jarvis WR, Emori TG, Horan TC Hughes JM CDC definitions for nosocomial infections, 1988. American Journal of Infection Control 1988, 16: 128–140.

    PubMed  CAS  Google Scholar 

  24. Blair JE, Willians REO Phage typing of staphylococci. Bulletin of the World Health Organization 1961, 24: 771–784.

    PubMed  CAS  Google Scholar 

  25. Working Party of the Hospital Infection Society and British Society for Antimicrobial Chemotherapy Revised guidelines for the control of epidemic methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1990, 16: 351–377.

    Google Scholar 

  26. Kerr S, Kerr GE, Mackintosh CA, Marples RR A survey of methicillin-resistantStaphylococcus aureus in England and Wales. Journal of Hospital Infection 1990, 16: 35–48.

    Article  PubMed  CAS  Google Scholar 

  27. Townsend DE, Ashdown N, Bolton S, Bradley J, Duckworth G, Moorhouse EC, Grubb WB The international spread of methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1987, 9: 60–71.

    Article  PubMed  CAS  Google Scholar 

  28. Phillips I Epidemicity of methicillin-resistantStaphylococcus aureus. In: Coello R, Casewell MW (ed): Methicillin-resistantStaphylococcus aureus. Wells Medical, Tunbridge Wells, UK 1993, p. 29–32.

    Google Scholar 

  29. Cookson BD, Phillips I Epidemic methicillin-resistantStaphylococcus aureus. Journal of Antimicrobial Chemotherapy 1988, 24, Supplement C: 57–65.

    Google Scholar 

  30. Boyce JM, Landry M, Deetz TR, DuPont HL Epidemiologic studies of an outbreak of nosocomial methicillin-resistantStaphylococcus aureus infections. Infection Control 1981, 2: 110–116.

    PubMed  CAS  Google Scholar 

  31. Locksley RM, Cohen ML, Quinn TC, Tompkins LS, Coyle MB, Kirihara JM, Counts GW Multiply antibiotic-resistantStaphylococcus aureus introduction, transmission and evolution of nosocomial infection. Annals of Internal Medicine 1982, 97: 317–324.

    PubMed  CAS  Google Scholar 

  32. Craven DE, Reed C, Kollisch N, DeMaria A, Lichtenberg D, Shen K, McCabe WR A large outbreak of infections caused by a strain ofStaphylococcus aureus resistant to oxacillin and aminoglycosides. American Journal of Medicine 1981, 71: 53–58.

    PubMed  CAS  Google Scholar 

  33. Bartzokas CA, Paton JH, Gibson MF, Graham R, McLoughlin GA, Croton RS Control and eradication of methicillin-resistantStaphylococcus aureus on a surgical unit. New England Journal of Medicine 1984, 311: 1422–1425.

    Article  PubMed  CAS  Google Scholar 

  34. Wenzel RP, Nettleman MD, Jones RN, Pfaller MD Methicillin-resistantStaphylococcus aureus implications for the 1990s and effective control measures. American Journal of Medicine 1991, 91, Supplement 3B: 221–227.

    Article  Google Scholar 

  35. Casewell MW, Hill RLR The carrier state: methicillin-resistantStaphylococcus aureus. Journal of Antimicrobial Chemotherapy 1986, 18, Supplement A: 1–12.

    PubMed  Google Scholar 

  36. Keane CT, Cafferkey MT Re-emergence of methicillin-resistantStaphylococcus aureus causing severe infections. Journal of Infection 1984, 9: 6–16.

    PubMed  CAS  Google Scholar 

  37. Myers JP, Linneman CC, Jr Bacteremia due to methicillin-resistantStaphylococcus aureus. Journal of Infectious Diseases 1982, 145: 532–536.

    PubMed  CAS  Google Scholar 

  38. Klimek JJ, Marsik FJ, Bartlett RC, Weir B, Shea P, Quintiliani R Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistantStaphylococcus aureus at a large community hospital. American Journal of Medicine 1976, 61: 340–345.

    PubMed  CAS  Google Scholar 

  39. Sapico FL, Montgomerie JZ, Canawati HN, Acilts G Methicillin-resistantStaphylococcus aureus bacteriuria. American Journal of the Medical Sciences 1981, 281: 101–109.

    PubMed  CAS  Google Scholar 

  40. Murray-Leisure KA, Geib S, Graceley D, Rubin-Slutsky AB, Saxena N, Muller HA, Hamory BH Control of epidemic methicillin-resistantStaphylococcus aureus. Infection Control and Hospital Epidemiology 1990, 11: 343–350.

    PubMed  CAS  Google Scholar 

  41. Bradley SF, Terpenning MS, Ramsey MA, Zarins LT, Jorgensen KA, Sottile WS, Schaberg DR, Kauffman CA Methicillin-resistantStaphylococcus aureus: colonization and infection in a long-term care facility. Annals of Internal Medicine 1991, 115: 417–422.

    PubMed  CAS  Google Scholar 

  42. White A Relation between quantitative nasal cultures and dissemination of staphylococci. Journal of Laboratory and Clinical Medicine 1961, 58: 273–277.

    PubMed  CAS  Google Scholar 

  43. Lidwell OM, Polakoff S, Jevons MP, Parker MT, Shooter RA, French VI, Duhkerley DR Staphylococcal infection in thoracic surgery: experience in a subdivided ward. Journal of Hygiene (Cambridge) 1966, 64: 321–337.

    CAS  Google Scholar 

  44. Williams REO Healthy carriage ofStaphylococcus aureus: its prevalence and importance. Bacteriological Reviews 1963, 27: 56–71.

    PubMed  CAS  Google Scholar 

  45. Lidwell OM, Polakoff S, Davies J, Hewitt JH, Shooter RA, Walker KA, Gaya H, Taylor GW Nasal acquisition ofStaphylococcus aureus in a subdivided and mechanically ventilated ward: endemic prevalence of a single staphylococcal strain. Journal of Hygiene (Cambridge) 1970, 68: 417–433.

    CAS  Google Scholar 

  46. Lidwell OM, Davies J, Payne RW, Newman P, Williams REO Nasal acquisition ofStaphylococcus aureus in partly divided wards. Journal of Hygiene (Cambridge) 1971, 69: 113–123.

    PubMed  CAS  Google Scholar 

  47. Williams REO, Jevons MP, Shooter RA, Hunter CJW, Girling JA, Griffiths JD, Taylor GW Nasal staphylococci and sepsis in hospital patients. British Medical Journal 1959, 2: 658–662.

    Article  PubMed  CAS  Google Scholar 

  48. Casewell MW, Hill RLR Minimal dose requirements for nasal mupirocin and its role in the control of epidemic MRSA. Journal of Hospital Infection 1991, 19, Supplement B: 35–40.

    Article  PubMed  Google Scholar 

  49. Rimland D, Roberson B Gastrointestinal carriage of methicillin-resistantStaphylococcus aureus. Journal of Clinical Microbiology 1986, 24: 137–138.

    PubMed  CAS  Google Scholar 

  50. Cookson BD, Peters B, Webster M, Phillips I, Rahman M, Noble W Staff carriage of epidemic methicillin-resistantStaphylococcus aureus. Journal of Clinical Microbiology 1989, 27: 1471–1476.

    PubMed  CAS  Google Scholar 

  51. Gaspar MC, Uribe P, Sánchez P, Coello R, Cruzet F Personal hospitalario portador nasal deStaphylococcus aureus resistente a meticilina. Utilidad del tratamiento con mupirocina. Enfermedades Infeciosas y Microbiología Clínica 1992, 10: 107–110.

    CAS  Google Scholar 

  52. Solberg CO A study of carriers ofStaphylococcus aureus. Acta Medica Scandinavica 1965, 178, Supplement: 436.

    Google Scholar 

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Authors and Affiliations

  1. Servicio de Medicina Preventiva, Hospital Universitario San Carlos, Martin Lagos S/N, 28040, Madrid, Spain

    R. Coello, J. Jiménez, M. García, P. Arroyo, D. Minguez, C. Fernández, F. Cruzet & C. Gaspar

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  1. R. Coello
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  2. J. Jiménez
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  4. P. Arroyo
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  5. D. Minguez
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  6. C. Fernández
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  7. F. Cruzet
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  8. C. Gaspar
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Coello, R., Jiménez, J., García, M. et al. Prospective study of infection, colonization and carriage of methicillin-resistantStaphylococcus aureus in an outbreak affecting 990 patients. Eur. J. Clin. Microbiol. Infect. Dis. 13, 74–81 (1994). https://doi.org/10.1007/BF02026130

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