title: Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection.
abstract: OBJECTIVE
  To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner.
  
  
  METHODS
  A medical practitioner's office and 4 hospitals in Perth, Western Australia.
  
  
  METHODS
  Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner.
  
  
  METHODS
  We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner.
  
  
  RESULTS
  Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified.
  
  
  CONCLUSIONS
  This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.
authors.affiliation: Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Royal Perth Hospital, West Perth, Perth, Western Australia. ronan.murray@health.wa.gov.au
authors.forename: R J
authors.initials: RJ
authors.lastname: Murray
authors.forename: J C
authors.initials: JC
authors.lastname: Pearson
authors.forename: G W
authors.initials: GW
authors.lastname: Coombs
authors.forename: J P
authors.initials: JP
authors.lastname: Flexman
authors.forename: C L
authors.initials: CL
authors.lastname: Golledge
authors.forename: D J
authors.initials: DJ
authors.lastname: Speers
authors.forename: J R
authors.initials: JR
authors.lastname: Dyer
authors.forename: D G
authors.initials: DG
authors.lastname: McLellan
authors.forename: M
authors.initials: M
authors.lastname: Reilly
authors.forename: J M
authors.initials: JM
authors.lastname: Bell
authors.forename: S F
authors.initials: SF
authors.lastname: Bowen
authors.forename: K J
authors.initials: KJ
authors.lastname: Christiansen
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000628:therapy; D004196:Disease Outbreaks; D005260:Female; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods; D017757:Infectious Disease Transmission, Professional-to-Patient; D007267:Injections / Q000009:adverse effects*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D052880:Pyomyositis / Q000628:therapy; D012785:Shoulder Joint / Q000187:drug effects / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D014904:Western Australia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents