Control and outcome of a large outbreak of colonization and infection with glycopeptide-intermediate Staphylococcus aureus in an intensive care unit.
BACKGROUND
Glycopeptide-intermediate Staphylococcus aureus (GISA) is emerging as a cause of nosocomial infection and outbreaks of infection and colonization in intensive care units (ICUs). We describe an outbreak of GISA colonization/infection and the ensuing control measures in an ICU and investigate outcomes of the affected patients.


METHODS
We describe an outbreak of GISA colonization and infection that affected 21 patients in a medical ICU at a tertiary care teaching hospital, as well as the measures taken to eradicate the GISA strain.


RESULTS
Recognition of the outbreak was difficult. Infections, all of which were severe, were diagnosed in 11 of 21 patients. Patient isolation and barrier precautions failed when used alone. Addition of a stringent policy of restricted admissions, twice daily environmental cleaning, and implementation of hand decontamination with a hydroalcoholic solution led to outbreak termination. This was associated with increases in workload, despite a marked decrease in the number of admissions.


CONCLUSIONS
This first description of a large outbreak of GISA colonization and infection underlines the importance of routine GISA-strain detection when methicillin-resistant S. aureus is isolated. Outbreak control may be difficult to achieve.
de Lassence
Arnaud
A
Medical-Surgical Intensive Care Unit, Louis-Mourier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France. arnaud.de-lassence@lmr.ap-hop-paris.fr
Hidri
Nadia
N
Timsit
Jean-François
JF
Joly-Guillou
Marie-Laure
ML
Thiery
Guillaume
G
Boyer
Alexandre
A
Lable
Pascale
P
Blivet
Annie
A
Kalinowski
Helene
H
Martin
Yolaine
Y
Lajonchere
Jean-Patrick
JP
Dreyfuss
Didier
D
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State; D003428:Cross Infection; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D006020:Glycopeptides / Q000494:pharmacology*; D006235:Hand Disinfection / Q000379:methods; D006282:Health Personnel; D006797:Housekeeping, Hospital; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D006020:Glycopeptides