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Control of epidemic methicillin-resistant Staphylococcus aureus in a Dutch university hospital
C M Vandenbroucke-Grauls1, H M Frénay, B van Klingeren
1Department of Clinical Microbiology, University Hospital, Utrecht, The Netherlands.
Abstract:
Between 1986 and 1989 a single strain of a methicillin- and multiply-resistant Staphylococcus aureus caused three distinct outbreaks at Utrecht University Hospital, involving 11, 19 and 32 patients, respectively. In all three episodes, members of staff were screened for MRSA carriage, and 58 persons were found to have positive nose cultures. In each outbreak it became necessary to isolate colonized and infected patients on a separate isolation ward. Staff carriers were also treated. Over the 18 months since the last outbreak, no new acquisitions of this epidemic MRSA strain have occurred. Between 1986 and 1989, the strain which caused the three outbreaks was not the only MRSA strain which was introduced into the hospital. Six other strains, which differed from the epidemic strain as shown by phage typing and antimicrobial susceptibility pattern, were found in single patients. The experience at Utrecht University Hospital illustrates the need for strict measures to eradicate epidemic strains of MRSA as well as the differences in "epidemicity" among various strains of MRSA.
Insights
A specific methicillin-resistant Staphylococcus aureus (MRSA) strain caused three hospital outbreaks, necessitating strict isolation and staff treatment. Eradication efforts successfully prevented further spread of this epidemic MRSA strain.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings.
- Controlling MRSA outbreaks requires understanding strain-specific characteristics and transmission dynamics.
Observation:
- Three distinct MRSA outbreaks occurred at Utrecht University Hospital between 1986 and 1989, affecting 11, 19, and 32 patients.
- Staff screening identified 58 carriers of the epidemic MRSA strain.
- Infected and colonized patients were isolated, and staff carriers received treatment.
Findings:
- The epidemic MRSA strain was successfully eradicated, with no new acquisitions in the 18 months following the last outbreak.
- Six other distinct MRSA strains were identified in single patients during the same period, highlighting diverse introductions.
- The epidemic strain demonstrated higher 'epidemicity' compared to other circulating MRSA strains.
Implications:
- Strict infection control measures are crucial for eradicating epidemic MRSA strains in hospitals.
- Understanding strain-specific virulence and transmissibility is essential for effective MRSA outbreak management.
- Hospitals must be vigilant against multiple MRSA strain introductions and possess robust surveillance systems.