Skip to main content
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1990 Oct;105(2):215–228. doi: 10.1017/s0950268800047828

Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burns units of a new hospital.

M Farrington 1, J Ling 1, T Ling 1, G L French 1
PMCID: PMC2271882  PMID: 2209730

Abstract

Multiple introductions of methicillin-resistant Staphylococcus aureus (MRSA) strains occurred to a new hospital in Hong Kong. Two years of clinical microbiological surveillance of the resulting outbreaks was combined with laboratory investigation by phage and antibiogram typing, and plasmid profiling. The outbreaks on the special care baby (SCBU) and burns (BU) units were studied in detail, and colonization of staff and contamination of the environment were investigated. MRSA were spread by the hands of staff on the SCBU, where long-term colonization of dermatitis was important, but were probably transmitted on the BU by a combination of the airborne, transient hand-borne and environmental routes. Simple control measures to restrict hand-borne spread on the SCBU were highly effective, but control was not successful on the BU.

Full text

PDF
218

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aly R., Maibach H. I., Shinefield H. R., Mandel A., Strauss W. G. Bacterial interference among strains of Staphylococcus aureus in man. J Infect Dis. 1974 Jun;129(6):720–724. doi: 10.1093/infdis/129.6.720. [DOI] [PubMed] [Google Scholar]
  2. Arnow P. m., Allyn P. A., Nichols E. M., Hill D. L., Pezzlo M., Bartlett R. H. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma. 1982 Nov;22(11):954–959. doi: 10.1097/00005373-198211000-00012. [DOI] [PubMed] [Google Scholar]
  3. BERNTSEN C. A., McDERMOTT W. Increased transmissibility of staphylococci to patients receiving an antimicrobial drug. N Engl J Med. 1960 Mar 31;262:637–642. doi: 10.1056/NEJM196003312621301. [DOI] [PubMed] [Google Scholar]
  4. Beard-Pegler M. A., Stubbs E., Vickery A. M. Observations on the resistance to drying of staphylococcal strains. J Med Microbiol. 1988 Aug;26(4):251–255. doi: 10.1099/00222615-26-4-251. [DOI] [PubMed] [Google Scholar]
  5. Boyce J. M., White R. L., Causey W. A., Lockwood W. R. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA. 1983 May 27;249(20):2803–2807. [PubMed] [Google Scholar]
  6. Cheng A. F., French G. L. Methicillin-resistant Staphylococcus aureus bacteraemia in Hong Kong. J Hosp Infect. 1988 Aug;12(2):91–101. doi: 10.1016/0195-6701(88)90131-4. [DOI] [PubMed] [Google Scholar]
  7. Crossley K., Loesch D., Landesman B., Mead K., Chern M., Strate R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis. 1979 Mar;139(3):273–279. doi: 10.1093/infdis/139.3.273. [DOI] [PubMed] [Google Scholar]
  8. Davies E. A., Emmerson A. M., Hogg G. M., Patterson M. F., Shields M. D. An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control. J Hosp Infect. 1987 Sep;10(2):120–128. doi: 10.1016/0195-6701(87)90137-x. [DOI] [PubMed] [Google Scholar]
  9. Duckworth G. J., Lothian J. L., Williams J. D. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect. 1988 Jan;11(1):1–15. doi: 10.1016/0195-6701(88)90034-5. [DOI] [PubMed] [Google Scholar]
  10. Dunkle L. M., Naqvi S. H., McCallum R., Lofgren J. P. Eradication of epidemic methicillin-gentamicin-resistant staphylococcus aureus in an intensive care nursery. Am J Med. 1981 Feb;70(2):455–458. doi: 10.1016/0002-9343(81)90787-7. [DOI] [PubMed] [Google Scholar]
  11. Dunkle L. M., Sippel C. J. Rapid microprocedure for extraction of plasmid DNA from Staphylococcus aureus. J Infect Dis. 1984 Jun;149(6):921–923. doi: 10.1093/infdis/149.6.921. [DOI] [PubMed] [Google Scholar]
  12. Espersen F., Nielsen P. B., Lund K., Sylvest B., Jensen K. Hospital-acquired infections in a burns unit caused by an imported strain of Staphylococcus aureus with unusual multi-resistance. J Hyg (Lond) 1982 Jun;88(3):535–541. doi: 10.1017/s002217240007039x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Everett E. D., McNitt T. R., Rahm A. E., Jr, Stevens D. L., Peterson H. E. Epidemiologic investigation of methicillin resistant Staphylococcus aureus in a burn unit. Mil Med. 1978 Mar;143(3):165–167. [PubMed] [Google Scholar]
  14. French G. L., Ling J. L., Hui Y. W., Oo H. K. Determination of methicillin-resistance in Staphylococcus aureus by agar dilution and disc diffusion methods. J Antimicrob Chemother. 1987 Oct;20(4):599–608. doi: 10.1093/jac/20.4.599. [DOI] [PubMed] [Google Scholar]
  15. French G. L., Ling J., Ling T., Hui Y. W. Susceptibility of Hong Kong isolates of methicillin-resistant Staphylococcus aureus to antimicrobial agents. J Antimicrob Chemother. 1988 May;21(5):581–588. doi: 10.1093/jac/21.5.581. [DOI] [PubMed] [Google Scholar]
  16. Gaston M. A., Duff P. S., Naidoo J., Ellis K., Roberts J. I., Richardson J. F., Marples R. R., Cooke E. M. Evaluation of electrophoretic methods for typing methicillin-resistant Staphylococcus aureus. J Med Microbiol. 1988 Jul;26(3):189–197. doi: 10.1099/00222615-26-3-189. [DOI] [PubMed] [Google Scholar]
  17. Gilbert G. L., Asche V., Hewstone A. S., Mathiesen J. L. Methicillin-resistant Staphylococcus aureus in neonatal nurseries. Two years' experience in special-care nurseries in Melbourne. Med J Aust. 1982 May 29;1(11):455–459. [PubMed] [Google Scholar]
  18. Gontijo Filho P. P., Stumpf M., Cardoso C. L. Survival of gram-negative and gram-positive bacteria artificially applied on the hands. J Clin Microbiol. 1985 Apr;21(4):652–653. doi: 10.1128/jcm.21.4.652-653.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Graham D. R., Correa-Villasenor A., Anderson R. L., Vollman J. H., Baine W. B. Epidemic neonatal gentamicin-methicillin--resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin. J Pediatr. 1980 Dec;97(6):972–978. doi: 10.1016/s0022-3476(80)80439-2. [DOI] [PubMed] [Google Scholar]
  20. Haley R. W., Bregman D. A. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis. 1982 Jun;145(6):875–885. doi: 10.1093/infdis/145.6.875. [DOI] [PubMed] [Google Scholar]
  21. Hill S. F., Ferguson D. Multiply-resistant Staphylococcus aureus (bacteriophage type 90) in a special care baby unit. J Hosp Infect. 1984 Mar;5(1):56–62. doi: 10.1016/0195-6701(84)90101-4. [DOI] [PubMed] [Google Scholar]
  22. Hone R., Keane C. T., Fitzpatrick S. Faecal carriage of staphylococcus aureus in infantile enteritis due to enteropathic Escherichia coli. Scand J Infect Dis. 1974;6(4):329–332. doi: 10.3109/inf.1974.6.issue-4.06. [DOI] [PubMed] [Google Scholar]
  23. Hunt J. L., Purdue G. F., Tuggle D. W. Morbidity and mortality of an endemic pathogen: methicillin-resistant Staphylococcus aureus. Am J Surg. 1988 Dec;156(6):524–528. doi: 10.1016/s0002-9610(88)80545-2. [DOI] [PubMed] [Google Scholar]
  24. Keane C. T., Cafferkey M. T. Re-emergence of methicillin-resistant Staphylococcus aureus causing severe infection. J Infect. 1984 Jul;9(1):6–16. doi: 10.1016/s0163-4453(84)94368-8. [DOI] [PubMed] [Google Scholar]
  25. Lejeune B., Buzit-Losquin F., Simitzis-Le Flohic A. M., Le Bras M. P., Alix D. Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children. J Hosp Infect. 1986 Jan;7(1):21–25. doi: 10.1016/0195-6701(86)90022-8. [DOI] [PubMed] [Google Scholar]
  26. Lidwell O. M., Davies J., Payne R. W., Newman P., Williams R. E. Nasal acquisition of Staphylococcus aureus in partly divided wards. J Hyg (Lond) 1971 Mar;69(1):113–123. doi: 10.1017/s002217240002132x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Linnemann C. C., Jr, Mason M., Moore P., Korfhagen T. R., Staneck J. L. Methicillin-resistant Staphylococcus aureus: experience in a general hospital over four years. Am J Epidemiol. 1982 Jun;115(6):941–950. doi: 10.1093/oxfordjournals.aje.a113381. [DOI] [PubMed] [Google Scholar]
  28. Locksley R. M., Cohen M. L., Quinn T. C., Tompkins L. S., Coyle M. B., Kirihara J. M., Counts G. W. Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med. 1982 Sep;97(3):317–324. doi: 10.7326/0003-4819-97-3-317. [DOI] [PubMed] [Google Scholar]
  29. Melo Cristino J. A., Pereira A. T., Afonso F., Naidoo J. N. Methicillin-resistant Staphylococcus aureus: a 6-month survey in a Lisbon paediatric hospital. J Hyg (Lond) 1986 Oct;97(2):265–272. doi: 10.1017/s0022172400065359. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Methicillin-resistant Staphylococcus aureus. Lancet. 1985 Sep 14;2(8455):605–606. [PubMed] [Google Scholar]
  31. Michel M. F., Priem C. C. Control at hospital level of infections by methicillin-resistant staphylococci in children. J Hyg (Lond) 1971 Sep;69(3):453–460. doi: 10.1017/s0022172400021707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Morrison A. J., Jr, Kaiser D. L., Wenzel R. P. A measurement of the efficacy of nosocomial infection control using the 95 per cent confidence interval for infection rates. Am J Epidemiol. 1987 Aug;126(2):292–297. doi: 10.1093/aje/126.2.292. [DOI] [PubMed] [Google Scholar]
  33. Mortimer E. A., Jr, Wolinsky E., Gonzaga A. J., Rammelkamp C. H., Jr Role of airborne transmission in staphylococcal infections. Br Med J. 1966 Feb 5;1(5483):319–322. doi: 10.1136/bmj.1.5483.319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. O'GRADY F., WITTSTADT F. B. Nasal carriage of Staphylococcus pyogenes. I. Lability of carriage in relation to carrier state, environmental staphylococcal load, and antibiotic therapy. Am J Hyg. 1962 Jan;75:136–145. [PubMed] [Google Scholar]
  35. Pearman J. W., Christiansen K. J., Annear D. I., Goodwin C. S., Metcalf C., Donovan F. P., Macey K. L., Bassette L. D., Powell I. M., Green J. M. Control of methicillin-resistant Staphylococcus aureus (MRSA) in an Australian metropolitan teaching hospital complex. Med J Aust. 1985 Jan 21;142(2):103–108. [PubMed] [Google Scholar]
  36. Price E. H., Brain A., Dickson J. A. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect. 1980 Sep;1(3):221–228. doi: 10.1016/0195-6701(80)90059-6. [DOI] [PubMed] [Google Scholar]
  37. Ransjö U., Malm M., Hambraeus A., Artursson G., Hedlund A. Methicillin-resistant Staphylococcus aureus in two burn units: clinical significance and epidemiological control. J Hosp Infect. 1989 May;13(4):355–365. doi: 10.1016/0195-6701(89)90055-8. [DOI] [PubMed] [Google Scholar]
  38. Reboli A. C., John J. F., Jr, Levkoff A. H. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child. 1989 Jan;143(1):34–39. doi: 10.1001/archpedi.1989.02150130044013. [DOI] [PubMed] [Google Scholar]
  39. Ribner B. S. Endemic, multiply resistant Staphylococcus aureus in a pediatric population. Clinical description and risk factors. Am J Dis Child. 1987 Nov;141(11):1183–1187. doi: 10.1001/archpedi.1987.04460110053021. [DOI] [PubMed] [Google Scholar]
  40. Richardson J. F., Chittasobhon N., Marples R. R. Supplementary phages for the investigation of strains of methicillin-resistant Staphylococcus aureus. J Med Microbiol. 1988 Jan;25(1):67–74. doi: 10.1099/00222615-25-1-67. [DOI] [PubMed] [Google Scholar]
  41. Rosdahl V. T., Laursen H., Bentzon M. W., Kjaeldgaard P., Thomsen M. Colonization priority among Staphylococcus aureus strains--correlation with phage-type. J Hosp Infect. 1988 Oct;12(3):151–162. doi: 10.1016/0195-6701(88)90002-3. [DOI] [PubMed] [Google Scholar]
  42. Shanson D. C. Antibiotic-resistant Staphylococcus aureus. J Hosp Infect. 1981 Mar;2(1):11–36. doi: 10.1016/0195-6701(81)90003-7. [DOI] [PubMed] [Google Scholar]
  43. Spicer W. J. Three strategies in the control of staphylococci including methicillin-resistant Staphylococcus aureus. J Hosp Infect. 1984 Dec;5 (Suppl A):45–49. doi: 10.1016/0195-6701(84)90029-x. [DOI] [PubMed] [Google Scholar]
  44. Trallero E. P., Arenzana J. G., Castañeda A. A., Grisolia L. P. Unusual multiresistant Staphylococcus aureus in a newborn nursery. Am J Dis Child. 1981 Aug;135(8):689–692. doi: 10.1001/archpedi.1981.02130320003002. [DOI] [PubMed] [Google Scholar]
  45. Zierdt C. H. Long-term Staphylococcus aureus carrier state in hospital patients. J Clin Microbiol. 1982 Sep;16(3):517–520. doi: 10.1128/jcm.16.3.517-520.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES