title: Clinical impact of MRSA in a stem cell transplant unit: analysis before, during and after an MRSA outbreak.
abstract: Meticillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen, with an increased incidence in the UK since 1993, causing serious morbidity and mortality in immunosuppressed patients. We analysed the frequency and outcome of MRSA infection in a single-centre transplant population over a 5-year period. The total number of patients infected was 41/776 (5%). The frequency in autologous, sibling and unrelated donor transplants was 3, 6 and 9%, respectively. Prior to 2004, the incidence was <4%/year; however, an outbreak in the day unit resulted in 22 patients becoming newly infected. Over 90% of infections were clinically relevant, half (49%) being bacteraemia. Three patterns were seen: known MRSA positive at any time before transplant (n=15), MRSA first detected during the neutropenia phase (n=5) and MRSA only post discharge (n=21). MRSA was implicated in a number of deaths, at all time points, in those infected. An intensive eradication policy resulted in new infections dropping to <2%. In conclusion, MRSA is likely to remain endemic in our unit, but robust early screening protocols and aggressive eradication strategies have effectively limited the spread of and morbidity due to this pathogen.
authors: Department of Clinical Haematology, Nottingham University Hospitals, Nottingham, UK. bshaw@dostors.org.uk
authors: B E
authors: BE
authors: Shaw
authors: T
authors: T
authors: Boswell
authors: J L
authors: JL
authors: Byrne
authors: C
authors: C
authors: Yates
authors: N H
authors: NH
authors: Russell
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000472:pathogenicity*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D006113:United Kingdom / Q000453:epidemiology