Nosocomial transmission of community-acquired methicillin-resistant Staphylococcus aureus in a well-infant nursery of a teaching hospital.
BACKGROUND
Infection due to community-acquired strains of methicillin-resistant Staphylococcus aureus (CA-MRSA) has been reported with increasing frequency. Herein is described the nosocomial transmission of CA-MRSA involving 13 neonates and two mothers in a well-infant nursery in a teaching hospital in Saudi Arabia.


METHODS
From October to November 2009, temporally related cases of CA-MRSA skin and soft-tissue infection occurred in newborns shortly after discharge from a well-infant nursery. An outbreak investigation including case identification, review of medical records, staff screening, environmental cultures, pulsed-field gel electrophoresis, and a case-control study were conducted. Controls were selected from among asymptomatic neonates admitted to the same nursery and matched for the day of admission.


RESULTS
Fifteen subjects were found to be CA-MRSA positive: 13 neonates and two mothers. The crude attack rate among neonates was 5.5% during the outbreak period. All 13 neonates presented with skin and soft-tissue infection; one of the mothers had mastitis and a breast abscess. The source of the outbreak was not evident. Pulsed-field gel electrophoresis showed that all of the tested isolates from one strain except one, all contained the staphylococcal cassette chromosome mec (SCCmec) type IV.


CONCLUSIONS
MRSA strains that initially emerged in the community are now causing disease in health-care settings. Adherence to standard infection control practices, including consistent hand hygiene, in newborn nurseries is important to prevent transmission in such settings.
Departments of Pediatrics, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia. salsubaie@ksu.edu.sa
Sarah
S
Alsubaie
Khawater
K
Bahkali
Ali M
AM
Somily
Fahad
F
Alzamil
Abdulkareem
A
Alrabiaah
Abdulkareem
A
Alaska
Fatmah
F
Alkhattaf
Abdelmageed
A
Kambal
Ahmed A
AA
Al-Qahtani
Mohammed N
MN
Al-Ahdal
D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*