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[Epidemic outbreak of methicillin-resistant Staphylococcus aureus in a general hospital. Preliminary report]
F Parras1, M Rodríguez, E Bouza
1Servicio de Microbiología Clínica, Hospital General Gregorio Marañón, Madrid.
Abstract:
The incidence of MRSA infections in Spain had remained in a low level through the years, being MRSA usually less than 1.5% of all S. aureus isolates. Since October 1988, we have detected in our hospital a MRSA outbreak. The epidemic started in the surgical wards, and spread through the rest of the institution. The incidence of cases was higher in the ICU's, areas that act as "multipliers" of the outbreak. In spite of standard control measures, the total number of patients with MRSA was 245 in April 1990. We studied prospectively a sample of 100 MRSA patients: thirty-six percent were colonized and 46% infected. The more common source of infection was the lower respiratory tract and primary bacteremia. The infection-related mortality was 30%. Our MRSA strain belong to phage type III, and shows a characteristic multiple antibiotic resistant pattern, the MRSA strain is sensitive to vancomycin, fusidic acid, phosphomycin and cotrimoxazole. Over the entire outbreak period, the MRSA strain developed resistance to rifampin, imipenem-cilastatin and ciprofloxacin. In spite of all control measures implemented, the outbreak can not have been totally controlled, and MRSA is now an endemic pathogen in our institution. Therefore, major changes in therapeutic approach to nosocomial infections have been since then introduced.
Insights
A hospital outbreak of Methicillin-resistant Staphylococcus aureus (MRSA) in Spain led to 245 cases by 1990. Despite control measures, MRSA became endemic, necessitating changes in treating hospital-acquired infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Context:
- Spain historically reported low Methicillin-resistant Staphylococcus aureus (MRSA) incidence (<1.5% of S. aureus isolates).
- A significant MRSA outbreak began in October 1988, originating in surgical wards and spreading institution-wide.
- Intensive Care Units (ICUs) acted as key transmission hubs, showing higher case incidence.
Purpose:
- To prospectively study a sample of 100 patients during a hospital-wide MRSA outbreak.
- To characterize the MRSA strain, infection sources, and outcomes.
- To evaluate the effectiveness of control measures and the long-term impact on endemicity.
Summary:
- The outbreak resulted in 245 MRSA cases by April 1990, with 36% colonization and 46% infection.
- Lower respiratory tract infections and primary bacteremia were common sources.
- Infection-related mortality reached 30%; the MRSA strain developed resistance to rifampin, imipenem-cilastatin, and ciprofloxacin.
Impact:
- Despite control efforts, the MRSA outbreak could not be fully contained, leading to endemic status.
- The study necessitated significant changes in the therapeutic approach to nosocomial infections within the institution.
- This highlights the challenge of controlling MRSA spread in healthcare settings and the need for evolving treatment strategies.