Deoxyribonucleic acid fingerprinting in an outbreak of Staphylococcus aureus intracranial infection after neurotologic surgery.
BACKGROUND
Meningitis is the most common life-threatening infection occurring as an early postoperative complication of neurotologic surgery. From January to March 2001, Staphylococcus aureus intracranial infection developed in three patients; two cases were consecutive.


METHODS
All staff members involved in surgery on any of the three patients had nasal swabs for S. aureus. The three patient isolates and all S. aureus isolates from staff members were typed by pulsed-field gel electrophoresis. Operating room procedures were reviewed.


RESULTS
All three patient isolates were identical by pulsed-field gel electrophoresis. Six staff members (40%) were found to be S. aureus carriers. The isolate from one staff members was identical to the patient isolates. A procedure audit of the operating room revealed several breaks in recommended practice. The staff carrier was immediately removed from patient care duties, given decolonization therapy, and treated for chronic rhinosinusitis. Practice changes in the operating room were implemented.


CONCLUSIONS
S. aureus remains a common cause of surgical site infections. S. aureus carriage is common, and carriers with intercurrent respiratory infections have increased shedding and are a higher risk to patients. Proper use of barrier devices and consistent hand hygiene reduce bacterial contamination of the wound. Current operating room technology involves technical personnel not traditionally trained in operating room procedures. Epidemiologic investigation may be delayed if operating room records are incomplete with respect to these personnel. Molecular typing of bacterial isolates can identify common source outbreaks and effectively focus investigations.
Hilton
Malcolm
M
Departments of Otorhinolaryngology and Microbiology, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
Chen
Joseph M
JM
Barry
Clare
C
Vearncombe
Mary
M
Simor
Andrew
A
D000328:Adult; D001927:Brain Diseases / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics; D001932:Brain Neoplasms / Q000601:surgery; D002353:Carrier State; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D004427:Ear Diseases / Q000601:surgery; D004432:Ear, Middle; D005260:Female; D006801:Humans; D008297:Male; D008503:Medical Staff; D009873:Operating Rooms; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics / Q000635:transmission; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics