An outbreak of methicillin-resistant Staphylococcus aureus infection in patients of a pediatric intensive care unit and high carriage rate among health care workers

Yu Chen Lin, Tsai Ling Lauderdale, Hui Min Lin, Pei Chen Chen, Ming Fang Cheng, Kai Sheng Hsieh, Yung Ching Liu

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background and Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) has been the leading cause of nosocomial infections in many hospitals. To investigate the impact of carriage by health care workers (HCWs) on patient transmission, surveillance culture was performed following an outbreak of MRSA in a pediatric intensive care unit (PICU). Methods: Isolates from 61 HCWs and 10 environmental sites were collected. Pulsed-field gel electrophoresis (PFGE) and antibiogram analysis were performed to determine the clonal relationship between isolates and potential routes of transmission. Results: The overall carriage rate of HCWs was 67.2% (41/61) for S. aureus and 26.2% (16/61) for MRSA. One MRSA was isolated from the 10 environmental sites sampled. Two major MRSA clusters were identified based on the PFGE patterns. Isolates with indistinguishable PFGE patterns (pulsotype A) were found in all patient isolates from the outbreak, from several HCWs plus the environmental isolate; all were resistant to ciprofloxacin, clindamycin, erythromycin, gentamicin, tetracycline, and trimethoprim-sulfamethoxazole. Interestingly, the isolate from a patient who had prolonged hospitalization in PICU had PFGE patterns (pulsotype B) distinct from the strains involved in the outbreak. This strain was susceptible to ciprofloxacin and trimethoprim-sulfamethoxazole, and was also found in several HCWs. Thus, there appeared to be 2 main MRSA clones circulating in the PICU of our hospital. Conclusions: Person-to-person and environment-to-person (or vice versa) transmissions are documented in this study. Strict hand washing before and after patient contact must be enforced and closely monitored, as it is the principal preventive measure in containing the spread of MRSA. To prevent the emergence of vancomycin-resistant MRSA and the further transmission of multidrug-resistant organisms, implementation of periodic and routine active surveillance cultures as part of infection control measures may also be evaluated.

Original languageEnglish
Pages (from-to)325-334
Number of pages10
JournalJournal of Microbiology, Immunology and Infection
Volume40
Issue number4
Publication statusPublished - Aug 2007
Externally publishedYes

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Pediatric Intensive Care Units
Methicillin-Resistant Staphylococcus aureus
Disease Outbreaks
Delivery of Health Care
Pulsed Field Gel Electrophoresis
Infection
Sulfamethoxazole Drug Combination Trimethoprim
Ciprofloxacin
Professional-to-Patient Infectious Disease Transmission
Hand Disinfection
Clindamycin
Microbial Sensitivity Tests
Erythromycin
Vancomycin
Infection Control
Cross Infection
Gentamicins
Tetracycline
Staphylococcus aureus
Hospitalization

Keywords

  • Carrier state
  • Cross infection
  • Infection control
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology and Allergy
  • Immunology and Microbiology(all)

Cite this

An outbreak of methicillin-resistant Staphylococcus aureus infection in patients of a pediatric intensive care unit and high carriage rate among health care workers. / Lin, Yu Chen; Lauderdale, Tsai Ling; Lin, Hui Min; Chen, Pei Chen; Cheng, Ming Fang; Hsieh, Kai Sheng; Liu, Yung Ching.

In: Journal of Microbiology, Immunology and Infection, Vol. 40, No. 4, 08.2007, p. 325-334.

Research output: Contribution to journalArticle

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T1 - An outbreak of methicillin-resistant Staphylococcus aureus infection in patients of a pediatric intensive care unit and high carriage rate among health care workers

AU - Lin, Yu Chen

AU - Lauderdale, Tsai Ling

AU - Lin, Hui Min

AU - Chen, Pei Chen

AU - Cheng, Ming Fang

AU - Hsieh, Kai Sheng

AU - Liu, Yung Ching

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AB - Background and Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) has been the leading cause of nosocomial infections in many hospitals. To investigate the impact of carriage by health care workers (HCWs) on patient transmission, surveillance culture was performed following an outbreak of MRSA in a pediatric intensive care unit (PICU). Methods: Isolates from 61 HCWs and 10 environmental sites were collected. Pulsed-field gel electrophoresis (PFGE) and antibiogram analysis were performed to determine the clonal relationship between isolates and potential routes of transmission. Results: The overall carriage rate of HCWs was 67.2% (41/61) for S. aureus and 26.2% (16/61) for MRSA. One MRSA was isolated from the 10 environmental sites sampled. Two major MRSA clusters were identified based on the PFGE patterns. Isolates with indistinguishable PFGE patterns (pulsotype A) were found in all patient isolates from the outbreak, from several HCWs plus the environmental isolate; all were resistant to ciprofloxacin, clindamycin, erythromycin, gentamicin, tetracycline, and trimethoprim-sulfamethoxazole. Interestingly, the isolate from a patient who had prolonged hospitalization in PICU had PFGE patterns (pulsotype B) distinct from the strains involved in the outbreak. This strain was susceptible to ciprofloxacin and trimethoprim-sulfamethoxazole, and was also found in several HCWs. Thus, there appeared to be 2 main MRSA clones circulating in the PICU of our hospital. Conclusions: Person-to-person and environment-to-person (or vice versa) transmissions are documented in this study. Strict hand washing before and after patient contact must be enforced and closely monitored, as it is the principal preventive measure in containing the spread of MRSA. To prevent the emergence of vancomycin-resistant MRSA and the further transmission of multidrug-resistant organisms, implementation of periodic and routine active surveillance cultures as part of infection control measures may also be evaluated.

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