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Molecular and epidemiological analysis of methicillin-resistant Staphylococcus aureus otorrhoea: hospital- or community-acquired?

Published online by Cambridge University Press:  18 June 2010

R G Nassif ,
R Soliman ,
D H Edwards ,
N Kara  and
S S M Hussain
R G Nassif*
Affiliation:
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
R Soliman
Affiliation:
Department of Medical Microbiology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
D H Edwards
Affiliation:
Department of Medical Microbiology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
N Kara
Affiliation:
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
S S M Hussain
Affiliation:
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
*
Address for correspondence: Mr Ramez George Nassif, Department of Otolaryngology, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK. Fax: +44 (0)1382 632816 E-mail: [email protected]
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Abstract

Objectives:

(1) To identify newly diagnosed cases of methicillin-resistant Staphylococcus aureus ear infection in our local population; (2) to determine the risk factors involved in these patients' clinical courses, and (3) to type the bacterial strains isolated and thus identify whether they were hospital- or community-acquired.

Design and setting:

Retrospective review of case notes, together with laboratory-based molecular studies in the departments of otolaryngology and medical microbiology in a university teaching hospital in Scotland, UK.

Subjects:

Over a two-year period, 35 patients were identified with ear swabs positive for methicillin-resistant Staphylococcus aureus infection. These cases came from both hospital and community settings.

Main outcome measures:

(1) Identification of primary methicillin-resistant Staphylococcus aureus otorrhoea in patients with no previously documented colonisation; and (2) molecular typing of the strains isolated, using spa technology, to identify whether they were hospital- or community-acquired.

Results:

Of the 35 positive patients, 27 were previously known carriers of methicillin-resistant Staphylococcus aureus. The eight patients with newly diagnosed methicillin-resistant Staphylococcus aureus otorrhoea presented initially in the community. All of these patients had had contact with hospital staff (as in-patients or out-patients) in the weeks preceding development of their ear infection. Using the spa technique for molecular typing, we identified hospital-acquired (‘epidemic’) methicillin-resistant Staphylococcus aureus type 15 in all eight patients' isolates. All were sensitive to topical gentamicin.

Conclusions:

In our cohort, hospital-acquired methicillin-resistant Staphylococcus aureus type 15 was the commonest cause of methicillin-resistant Staphylococcus aureus otorrhoea, despite the fact that these patients all first presented in the community. We believe that contact with hospital staff or health care workers is a risk factor for acquiring methicillin-resistant Staphylococcus aureus otorrhoea in the community.

Keywords

MRSAExternal Auditory CanalOtorrhoeaHospital Acquired Infections
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 12 , December 2010 , pp. 1247 - 1250
Copyright
Copyright © JLO (1984) Limited 2010

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References

1Ayliffe, GAJ. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1997;24(Suppl. 1):S74–9CrossRefGoogle ScholarPubMed
2Wang, JT, Chang, S, Ko, WK. A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier. J Hosp Infect 2001;47:110–15CrossRefGoogle ScholarPubMed
3Al-Shawwa, BA, Wegner, D. Trimethoprim-sulfamethoxazole plus topical antibiotics as therapy for acute otitis media with otorrhoea caused by community-acquired methicillin-resistant Staphylococcus aureus in children. Arch Otolaryngol Head Neck Surg 2005;13:782–4CrossRefGoogle Scholar
4Koreen, L, Ramaswamy, SV, Graviss, EA, Naidich, S, Musser, JM, Kreiswirth, BN. Spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro- and macro variation. J Clin Microbiol 2004;42:792–9CrossRefGoogle Scholar
5Malachowa, N, Sabat, A, Gniadkowski, M, Krzyszton-Russjan, J, Empel, J, Miedzobrodzki, J et al. Comparison of multiple-locus variable-number tandem-repeat analysis with pulsed-field gel electrophoresis, spa typing, and multilocus sequence typing for clonal characterization of Staphylococcus aureus isolates. J Clin Microbiol 2005;43:3095–100CrossRefGoogle ScholarPubMed
6Harmsen, D, Claus, H, Witte, W, Rothganger, J, Claus, H, Turnwald, D et al. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442–8CrossRefGoogle Scholar
7Von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteraemia. N Engl J Med 2001;344:11–16CrossRefGoogle Scholar
8Yeo, SG, Park, DC, Hong, SM, Cha, CI, Kim, MG. Bacteriology of chronic suppurative otitis media – a multicenter study. Acta Otol 2007;127:1062–7CrossRefGoogle ScholarPubMed
9Hwang, JH, Chu, C-K, Liu, TC. Changes in bacteriology of discharging ears. J Laryngol Otol 2002;116:686–9CrossRefGoogle ScholarPubMed
10Cotticchia, JM, Dohar, JE. Methicillin-resistant Staphylococcus aureus otorrhoea after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg 2005;131:868–73CrossRefGoogle Scholar
11Hunt, A, Robb, PJ. Successful treatment of MRSA otorrhoea: a case report. J Laryngol Otol 2006;120:63–4CrossRefGoogle ScholarPubMed
12Gillet, Y, Issartel, B, Vanhems, P, Fournat, JC, Lina, G, Bes, M et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leucocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2000;359:753–9CrossRefGoogle Scholar
13Nathwani, D, Morgan, M, Masterton, R, Dryden, M, Cookson, BD, French, G et al. , for the British Society for Antimicrobial Chemotherapy Working Party on Community-onset MRSA Infections. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother 2008;61:976–94CrossRefGoogle Scholar
14Hwang, JH, Tsai, HY, Liu, TC. Community-acquired methicillin resistant Staphylococcus aureus infection in discharging ears. Acta Otolaryngol 2002;122:827–30CrossRefGoogle ScholarPubMed
15Deurenberg, RH, Vink, C, Kalenic, S, Friedrich, AW, Bruggeman, CA, Stobberingh, E. The molecular evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2007;13:222–35CrossRefGoogle ScholarPubMed
16Frenay, HM, Bunschoten, AE, Schouls, LM, Van Leeuwen, WJ, Vandenbroucke-Grauls, CM, Mooi, FR. Molecular typing of methicillin-resistant Staphylococcus aureus on the basis of protein A gene polymorphism. Eur J Clin Microbiol Infect Dis 1996;15:60–4CrossRefGoogle ScholarPubMed
17Harmsen, D, Claus, H, Vogel, U. DNA sequence-based tandem repeat analysis of the clfB gene is less discriminatory than spa typing for methicillin-resistant Staphylococcus aureus. Int J Med Microbiol 2005;294:525–8CrossRefGoogle ScholarPubMed
18Saunders, JE, Raju, PR, Boone, J, Berryhill, W. Current bacteriology of suppurative otitis: resistant patterns and outcome analysis. Otology and Neurootology 2009;30:339–43CrossRefGoogle Scholar
19Yang, JA, Kim, JY, Yoon, YK, Kim, S, Park, DW, Sohn, JW et al. Epidemiological and genetic characterisation of methicillin-resistant Staphylococcus aureus isolates from the ear discharge of outpatients with chronic otitis media. J Korean Med Sci 2008;23:762–6CrossRefGoogle ScholarPubMed
20Mandell, GL, Bennett, JE, Dolin, R. Principles and Practice of Infectious Diseases. London: Churchill Livingstone, 2000;2069–92Google Scholar