title: Report of a hospital neonatal unit outbreak of community-associated methicillin-resistant Staphylococcus aureus.
abstract: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) with the type IV staphylococcal chromosomal cassette mec (SCCmec) is rarely reported as being acquired in hospital. We report a hospital outbreak, in Grampian, Scotland, of eight cases of skin and soft-tissue infections due to such a strain. All patients had been in the labour, delivery and maternity units of a small community hospital during a 7-month period. Typing by pulsed-field gel electrophoresis showed the isolates to be a single strain closely related to the USA800 lineage (paediatric clone) and additional typing confirmed it as ST5-MRSA-IV. Genes for exfoliative toxin A (ETA) and enterotoxin D were detected by PCR in all the isolates although none carried the Panton-Valentine leukocidin gene. Region-wide surveillance of over 6000 MRSA isolates collected from 1998 to 2004 showed that 95 (1.6%) were closely related to the outbreak strain although only 60 carried the ETA gene. The strain has not been seen elsewhere in Scotland.
authors.affiliation: Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK. i.m.gould@abdn.ac.uk
authors.forename: I M
authors.initials: IM
authors.lastname: Gould
authors.forename: E K
authors.initials: EK
authors.lastname: Girvan
authors.forename: R A
authors.initials: RA
authors.lastname: Browning
authors.forename: F M
authors.initials: FM
authors.lastname: MacKenzie
authors.forename: G F S
authors.initials: GF
authors.lastname: Edwards
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005083:Exfoliatins / Q000235:genetics; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D046915:Penicillin-Binding Proteins; D012606:Scotland / Q000453:epidemiology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology*
chemical_list: D001426:Bacterial Proteins; D005083:Exfoliatins; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus