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Methicillin-Resistant Staphylococcus Aureus: Interstate Spread of Nosocomial Infections with Emergence of Gentamicin-Methicillin Resistant Strains

Published online by Cambridge University Press:  31 March 2016

George Saroglou ,
Margaret Cromer  and
Alan L. Bisno
George Saroglou
Affiliation:
Hospital Infection Control Program, City of Memphis Hospital, and Division of Infectious Diseases, Department of Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee
Margaret Cromer
Affiliation:
Hospital Infection Control Program, City of Memphis Hospital, and Division of Infectious Diseases, Department of Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee
Alan L. Bisno*
Affiliation:
Hospital Infection Control Program, City of Memphis Hospital, and Division of Infectious Diseases, Department of Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee
*
956 Court Avenue, Room 3H1S, Memphis, TN 38163
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Abstract

A methicillin-resistant strain of Staphylococcus aureus (MRSA, phage type 84/85) was introduced into City of Memphis Hospital by a burn patient who had recently been treated for MRSA bacteremia in another institution 500 miles distant. Despite prompt recognition of the problem and institution of isolation procedures, six other patients developed secondary colonization during the ensuing six months, and five of these experienced clinically significant infections with MRSA. Three of the patients originally infected with MRSA, as well as two additional patients, subsequently developed colonization with staphylococcal strains of phage type 84/85 that were resistant to both methicillin and gentamicin (MRGRSA). Spread of the staphylococcal strains was most likely accomplished primarily via passive transfer from person to person. The hydrotherapy unit, which became contaminated with both MRSA and MRGRSA, may have played a secondary role. As illustrated by this outbreak, patients carrying potentially dangerous bacterial strains should be identified and informed of the problems posed by such carriage. It may be imprudent to admit such patients to hospitals that are free of the potential pathogen.

The outbreak described here exemplifies a number of potential problems associated with control of nosocomial staphylococcal infections: (a) interhospital spread of methicillin-resistant strains; (b) secondary patient-to-patient intrahospital spread; and (c) emergence of even more resistant strains, possibly associated with selective pressures exerted by widespread use of broad-spectrum antimicrobial agents.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 1 , Issue 2 , April 1980 , pp. 81 - 89
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1980

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References

1.Parker, MT, Hewitt, JH. Methicillin-resisiance in Staphylococcus aureus. Lancet i:800, 1970.CrossRefGoogle Scholar
2.Kayser, FH: Methicillin-resistant staphylococci, 1965-75. Lancet ii:650, 1975.Google Scholar
3.Jessen, O, Rosendal, K, Bulow, P, et al.Changing staphylococci and staphylococcal infections. A ten-year study of bacteria and cases of bacteremia. N Engl J Med 281:627, 1969.Google Scholar
4.Parker, MT, Asheshov, EH, Hewitt, JH, et al.Endemic staphylococcal infection in hospitals. Ann NY Acad Sci 236:466, 1974.CrossRefGoogle ScholarPubMed
5.Shanson, DC, Kensit, JG, Duke, R. Outbreak of hospital infection with a strain of Staphylococcus aureus resistant to gentamicin and methicillin. Lancet ii:1347, 1976.CrossRefGoogle Scholar
6.Buckwold, FJ, Albriiion, WL, Ronald, AR, et al.Investigations of the occurrence of gentamicin-resisiam Staphylococcusaureus. Antimicrob Agents Chemother 15:152, 1979.Google Scholar
7.Bint, JA, George, RH, Healing, DE, et al.An outbreak of infection caused by a gentamicin-resistant Staphylococcus aureus. J Clin Pathol 30:165, 1977.Google Scholar
8.O'Toole, RD, Drew, L, Dahlgren, BJ, et al.An outbreak of methicillin-resistant Staphylococcus aureus infections. Observations in hospital and nursing home. JAMA 213:257, 1970.CrossRefGoogle ScholarPubMed
9.Barrett, FF, McGehee, RJ Jr, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital. Bacteriologie and epidemiologic observations. N Engl J Med 279:441, 1968.Google Scholar
10.Klimek, JJ, Marsik, FJ, Bartlett, RC, et al:Clinical, epidemiologic and bacteriologie observations of an outbreak of methicillin-resistant Staphylococcus aureus ai a large community hospital. Am J Med 61:340, 1976.CrossRefGoogle Scholar
11.Sieger, BE, Long, JM, Lindberg, RB, et al.Methicillin-resistant staphylococci in thermally injured patients: Clinical aspects. 15th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington DC, Abstract #152, 1975.Google Scholar
12.Richmond, AS, Simberkoff, MS, Schaefler, S, et al.Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin. J Infect Dis 135:108, 1977.Google Scholar
13.Nicholas, P, Pringle, G, Malowany, M. Hospital infections caused by methicillin-resistant Staphylococcus aureus (MR/SA): Clinical and bacteriologie aspects. 16th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, Abstract #144, 1976.Google Scholar
14.Everett, ED, Rahm, AE, Nitt, MS, et al.Epidemiologic investigation of methicillin resistant Staphylococcus aureus in a burn unit. Milit Med 143:165, 1978.CrossRefGoogle Scholar
15.Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. J Infect Dis 139:280, 1979.Google Scholar
16.Faden, H. Gentamicin-resistant Staphylococcus aureus. Emergence in an intensive care nursery. JAMA 241:143, 1979.CrossRefGoogle Scholar
17.Greenwood, GP, Hill, DL, Dixon, RE, et al.Changing phage typing patterns of epidemic gentamicin-resistant Staphylococcus aureus. Lancet i:289, 1979.Google Scholar
18.Speller, DCE, Raghunath, D, Stephen, M, et al.Epidemic infection by a gentamicin-resistant Staphylococcus aureus in three hospitals. Lancet i:464, 1976.Google Scholar
19.Sieger, BE, Long, JM, Lindberg, RB, et al.Methicillin-resistant staphylococci in thermally injured patients: Epidemiologic aspects. 16th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, Abstract #282, 1976.Google Scholar
20.Kaslow, RA, Lindsey, JO, Bisno, AL, et al.An epidemic of nosocomial infection with highly resistant Proteus rettgeri. Am J Epidem 104:278, 1976.Google Scholar
21.Scott, DF, Wood, DO, Brownell, GH, et al.Aminoglycoside modification by gentamicin-resistant isolates of Staphylococcus aureus. Antimicrob Agents Chemother 13:641, 1978.CrossRefGoogle ScholarPubMed
22.Fouace, J. Transferor resistance plasmids in Staphylococcus aureus. Ann Microbiol 125A:517, 1974.Google Scholar
23.Soussy, CJ, Bouanchaud, DH. Fouace, J, et al.A gentamicin resistance plasmid in Staphylococcus aureus. Ann Microbiol 126B:91, 1975.Google ScholarPubMed
24.Wood, DO, Carter, MJ, Best, GK. Plasmid-mediated resistance to gentamicin in Staphylococcus aureus. Antimicrob Agents Chemother 12:513, 1977.CrossRefGoogle ScholarPubMed
25.Dowding, JE. Mechanisms of gentamicin resistance in Staphylococcus aureus. Antimicrob Agents Chemother 11:47, 1977.Google Scholar
26.Jaffe, H, Sweeney, H, Nathan, C, et al.Identity and interspecific transfer of gentamicin-resistance plasmids in Staphylococcus aureus. 19th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, MA, Abstract #639, 1979.Google Scholar
27.Wilson, SG, Sanders, CC. Selection and characterization of strains of Staphylococcus aureus displaying unusual resistance to aminoglycosides. Antimicrob Agents Chemother 10:519, 1976.Google Scholar
28.Musher, DM, Baughn, RE, Templeton, GB, et al.Emergence of variant forms of Staphylococcus oureujafterexposure to gentamicin and infectivity of the variants in experimental animals. J Infect Dis 136:360, 1977.CrossRefGoogle ScholarPubMed
29.Miller, MH, Wexler, MA, Steigbigel, NH. Single and combination antibiotic therapy of Staphylococcus aureus experimental endocarditis: Emergence of gentamicin resistant mutans. Antimicrob Agents Chemother 14:336, 1978.CrossRefGoogle Scholar