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An Outbreak of Mupirocin-Resistant Staphylococcus aureus on a Dermatology Ward Associated with an Environmental Reservoir

Published online by Cambridge University Press:  21 June 2016

Marcelle C. Layton ,
Maritza Perez ,
Peter Heald  and
Jan Evans Patterson
Marcelle C. Layton
Affiliation:
Departments of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
Maritza Perez
Affiliation:
Dermatology, Yale University School of Medicine, New Haven, Connecticut
Peter Heald
Affiliation:
Dermatology, Yale University School of Medicine, New Haven, Connecticut
Jan Evans Patterson*
Affiliation:
Departments of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
*
Infectious Diseases Section, Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284
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Abstract

Objective:

To investigate a cluster of mupirocin-resistant Staphylococcus aureus on a dermatology ward.

Design:

An outbreak of mupirocin-resistant S aureus was noted on the dermatology ward during a prospective epidemiologic study of methicillin-resistant S aureus (MRSA) and borderline methicillin-susceptible S aureus (BMSSA). Pulsed-field gel electrophoresis (PFGE) of whole-cell DNA digested with Sma I was used as a marker of strain identity.

Setting and Patients:

An 850-bed university hospital with a 12-bed inpatient dermatology ward. Most patients have severe, exfoliating dermatologic disorders.

Results:

MRSA or BMSSA were isolated from 13 patients on the dermatology ward over a 14-month period. Eleven of these isolates (84.6%) were mupirocin-resistant. Nine isolates were present on admission (81.8%); 8 of these patients had been hospitalized on the same ward within the last two months. Nasal and hand cultures from 36 personnel were negative for mupirocin-resistant MRSA or BMSSA. Extensive environmental culturing revealed that a blood pressure cuff and the patients' communal shower were positive for mupirocin-resistant BMSSA. PFGE of all mupirocin-resistant isolates demonstrated that the nine patients and both environmental sources had identical DNA typing patterns.

Interventions:

Changing of blood pressure cuffs between patients and more stringent cleaning of communal areas was initiated. Repeat environmental cultures were negative.

Conclusions:

S aureus is not usually associated with an environmental reservoir; however, these patients all had severe desquamation, which may have prolonged environmental contamination.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 7 , July 1993 , pp. 369 - 375
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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