title: Hospital-related outbreak of infection with multidrug-resistant Streptococcus pneumoniae in the Netherlands.
abstract: Multidrug-resistant strains of Streptococcus pneumoniae were isolated over a two-year period (July 1995 until August 1997) from the sputum of 36 patients who were hospitalized in a Dutch medical centre. Nosocomial transmission was confirmed by typing of the bacterial isolates: all 36 multidrug-resistant isolates shared the same genotype, serotype, and displayed overlapping drug resistance profiles. Thirty-two of the 36 (89%) patients had chronic obstructive pulmonary disease (COPD). The outbreak was initiated by a 76-year old patient, who had been colonized with the same strain since 1993. Because staff screening of the hospital and pulmonary function department was negative, patient-to-patient spread was the most likely cause of this outbreak. The epidemic ceased following the commencement of barrier nursing, a treatment course of ceftriaxone, and a five-day rifampicin eradication therapy for the positive patients. The outbreak resulted from failure to recognize quickly the rapid transmission of this multidrug-resistant pneumococcal clone. We conclude that patients with COPD are at high risk of acquiring multidrug resistant pneumococci, and suggest that COPD patients who are colonized or infected with multidrug-resistant pneumococci should be isolated to prevent future transmission.
authors.affiliation: Department of Internal Medicine, St. Joseph's Hospital, Veldhoven, The Netherlands.
authors.forename: B E
authors.initials: BE
authors.lastname: de Galan
authors.forename: P M
authors.initials: PM
authors.lastname: van Tilburg
authors.forename: M
authors.initials: M
authors.lastname: Sluijter
authors.forename: S J
authors.initials: SJ
authors.lastname: Mol
authors.forename: R
authors.initials: R
authors.lastname: de Groot
authors.forename: P W
authors.initials: PW
authors.lastname: Hermans
authors.forename: A R
authors.initials: AR
authors.lastname: Jansz
mesh_terms: D000368:Aged; D002353:Carrier State / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013183:Sputum / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification