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Observations Relating to an Inter-Hospital Outbreak of Methicillin-Resistant Staphylococcus aureus: Role of Antimicrobial Therapy in Infection Control

Published online by Cambridge University Press:  02 January 2015

Thomas T. Ward ,
Rick E. Winn ,
Alan I. Hartstein  and
David L. Sewell
Thomas T. Ward*
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
Rick E. Winn
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
Alan I. Hartstein
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
David L. Sewell
Affiliation:
Infectious Diseases Section, Department of Medicine, Portland Veterans Administration Medical Center, andUniversity of Oregon Health Sciences Center, Portland, Oregon
*
Infectious Disease Section, Department of Medicine, Portland VA Medical Center, Portland, Oregon 97201
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Abstract

Clinical, bacteriologie, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p < 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p < 0.01), but, in contrast to previous studies, this was not a significant risk factor (p > 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p < 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus. [Infect Control 1981; 2(6):453-459.]

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 2 , Issue 6 , December 1981 , pp. 453 - 459
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1981

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