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[Long-term carrier state of methicillin resistant Staphylococcus aureus after hospitalization]
G Pedersen1, N H Larsen, H C Schønheyder
1Klinisk mikrobiologisk afdeling, Aalborg Sygehus.
Abstract:
In Denmark, strains of methicillin-resistant (MR) Staphylococcus aureus constitute less than 0.1% of all S. aureus isolates and are often acquired abroad. A strain of MR S. aureus phage type 77+ was isolated from a patient, who had been hospitalized in a Portuguese hospital three months earlier. In Denmark, the patient had been admitted to a private clinic for replacement of the aortic valve and a coronary bypass operation. The strain did not produce detectable soluble coagulase, and it was multiply resistant, including resistance to gentamicin, tetracycline, erythromycin, and rifampicin. It was probably non-invasive. Thirty-seven members of the staff were screened for MR S. aureus with negative results. The patient was treated with chlorhexidine to eliminate carriage, but, eight weeks after treatment, he was still colonized. Thus, in the current epidemiological situation in Denmark, it is important to take into consideration that carriage of MR S. aureus may last several months. We therefore suggest, that specific guidelines for hospital hygiene should be upheld not only for patients, who are transferred directly from hospitals in other countries, but also for patients, who have been hospitalized abroad within the last three to six months.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) carriage can persist for months after international travel. Enhanced hospital hygiene guidelines are crucial for patients with recent foreign hospitalization to prevent MRSA spread.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Microbiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is rare in Denmark, with isolates often linked to foreign acquisition.
- A specific MRSA strain (phage type 77+) was identified in a patient with recent hospitalization in Portugal.
Observation:
- The patient underwent cardiac surgery in Denmark after prior hospitalization abroad.
- The isolated MRSA strain exhibited multidrug resistance, including to gentamicin, tetracycline, erythromycin, and rifampicin.
- The strain was likely non-invasive, and staff screening yielded negative MRSA results.
Findings:
- Despite chlorhexidine treatment, the patient remained colonized with MRSA eight weeks post-treatment.
- This case highlights the potential for prolonged MRSA carriage, even after attempted decolonization.
Implications:
- Healthcare facilities in Denmark must consider MRSA risk in patients with recent foreign hospitalization (within 3-6 months).
- Strengthening hospital hygiene protocols is essential for managing MRSA, particularly for repatriated patients.
- Extended screening and hygiene measures may be necessary to control MRSA transmission in low-prevalence settings.