title: An outbreak of mupirocin-resistant Staphylococcus aureus on a dermatology ward associated with an environmental reservoir.
abstract: OBJECTIVE
  To investigate a cluster of mupirocin-resistant Staphylococcus aureus on a dermatology ward.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: M C
authors.initials: MC
authors.lastname: Layton
authors.forename: M
authors.initials: M
authors.lastname: Perez
authors.forename: P
authors.initials: P
authors.lastname: Heald
authors.forename: J E
authors.initials: JE
authors.lastname: Patterson
mesh_terms: D001795:Blood Pressure Determination / Q000295:instrumentation; D003237:Connecticut / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D003880:Dermatology; D004196:Disease Outbreaks; D004197:Disease Reservoirs; D004352:Drug Resistance, Microbial; D004866:Equipment Contamination; D006757:Hospital Units; D006785:Hospitals, University; D006801:Humans; D016106:Methicillin Resistance; D016712:Mupirocin / Q000494:pharmacology*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D016712:Mupirocin