title: [Outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in the Rijnmond region: the largest outbreak in the Netherlands].
abstract: EPIDEMIC: The annual number of new MRSA isolates in the Netherlands tripled in 2002 compared with previous years. This increase was in part due to a MRSA outbreak in the Rijnmond region. The outbreak occurred in two merged hospitals and is the largest ever to occur in the Netherlands. From November 2001 till June 2003 MRSA was isolated from 381 patients and 113 hospital employees. The worst affected departments were Surgery and Internal Medicine. One MRSA strain (pulsed-field gel electroforesis (PFGE) type 16) remained initially unrecognised and was therefore able to spread unnoticed. Soon two additional epidemic MRSA strains (types 37 and 38) were discovered.
  
  
  CONCLUSIONS
  Multiple factors played a role in the extent and duration of the outbreak. Because of the delayed detection and rapid spread of MRSA type 16, the outbreak grew too large once recognised to be resolved within the available infrastructure. Investments were needed at various fields, including the infection-control service and the microbiology laboratory. Employees had to be informed and motivated, and a separate MRSA ward and OPD were provided. New MRSA outbreaks occurred, despite extensive MRSA (contact) screening among patients and employees. The numbers of isolates began falling as from the beginning of 2003.
authors.affiliation: Erasmus Medisch Centrum, afd. Medische Microbiologie en Infectieziekten, Dr. Molewaterplein 40, 3015 GD Rotterdam. d.melles@erasmusmc.nl
authors.forename: D C
authors.initials: DC
authors.lastname: Melles
authors.forename: W D
authors.initials: WD
authors.lastname: Hendriks
authors.forename: A
authors.initials: A
authors.lastname: Ott
authors.forename: H A
authors.initials: HA
authors.lastname: Verbrugh
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control*; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods; D016106:Methicillin Resistance; D009426:Netherlands / Q000453:epidemiology; D012703:Serotyping; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity