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Methicillin-resistant Staphylococcus aureus: a four-year experience in a spinal cord injury unit in Spain
M Olona-Cabases1, N Ticó-Falguera, L Ramírez-Garcerán
1Spinal Cord Injury Unit, Traumatology and Rehabilitation University Hospital, Barcelona, Spain.
Abstract:
Methicillin-Resistant Staphylococcus aureus (MRSA) infection poses a problem for both acute and long-term-care facilities, Spinal Cord Injury units included. This paper describes the 4-year evolution of MRSA outbreaks in a SCI unit in a university hospital where control measures were implemented from the first case detected. The protocol procedure was as follows: contact isolation, washing with antiseptic soap both those infected and those sharing the same room, contacts study and monitoring of MRSA patients up to the time when three consecutive negative cultures (sampled at time lapses of over 48 h) were obtained, antiseptic soap for the health-care personnel to wash their hands, and cultures of the nares done on the personnel in the event of an outbreak. Twenty-one (3.4%) MRSA positive cases were detected out of 550 admissions registered during the study period (November 1990 through October 1994). The evolution occurred in three outbreaks and six isolated MRSA positive patients without secondary cases. 71.5% of the cases were nosocomial. Seven (33%) were colonizated and 14 (67%) infected. The 14 patients infected presented 15 infections: nine with urinary tract infections, three surgical wound infections, two tracheostomy wound infections, and one patient with a decubitus ulcer infection. Two of those with urinary tract infections presented with secondary sepsis. No carriers were detected amongst the personnel. Urinary tract colonizations responded to treatment with cotrimoxazol except in two cases in which combined treatment was required (cotrimoxazol plus rifampicin). The patients with a MRSA positive tracheal aspirate were negative after combined treatment. Wounds and cultures of the nares responded favorably to initial treatment. One of the patients with a urinary tract infection and sepsis died the infection being a contributing cause. The prospective follow-up of the patients with MRSA positive cultures and the precocious implementation of isolation measures allow for the limitation of transmission, even although complete eradication is not possible.
Insights
Implementing strict contact isolation and hygiene protocols helped limit Methicillin-Resistant Staphylococcus aureus (MRSA) transmission in a Spinal Cord Injury unit. While complete eradication wasn't achieved, proactive measures reduced MRSA outbreaks and infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Infection Control
Background:
- Methicillin-Resistant Staphylococcus aureus (MRSA) presents a significant challenge in healthcare settings, including specialized Spinal Cord Injury (SCI) units.
- Controlling MRSA transmission is crucial to prevent patient harm and manage healthcare-associated infections.
Purpose of the Study:
- To describe the 4-year evolution of MRSA outbreaks in a university hospital's SCI unit.
- To evaluate the effectiveness of implemented control measures in limiting MRSA transmission.
Main Methods:
- A protocol involving contact isolation, antiseptic washing for patients and staff, contact tracing, and patient monitoring until negative cultures were achieved.
- Surveillance included cultures of nares for healthcare personnel during outbreaks.
- Data collected from November 1990 to October 1994.
Main Results:
- Twenty-one (3.4%) MRSA-positive cases were identified among 550 admissions.
- The majority of cases (71.5%) were nosocomial, occurring across three outbreaks and six isolated cases.
- Urinary tract infections were the most common infection type (9/15), with two cases leading to sepsis; one patient died.
Conclusions:
- Prospective follow-up and early implementation of isolation measures effectively limited MRSA transmission in the SCI unit.
- While complete eradication proved difficult, the control strategy significantly reduced the impact of MRSA.
- Antimicrobial treatments, including combination therapy, were effective for various MRSA colonization and infection sites.