title: Infection control for a methicillin-resistant Staphylococcus aureus outbreak in an advanced emergency medical service center, as monitored by molecular analysis.
abstract: A methicillin-resistant Staphylococcus aureus (MRSA) outbreak occurred in an advanced emergency medical service center between 2010 and 2011. Our objective was to evaluate the status of the MRSA outbreak, as monitored by molecular analysis. Twenty-eight MRSA strains were isolated from blood samples from 11 patients, from other specimens (pharynx, nasal cavity, etc.) from 12 patients, from two environmental samples, and from the skin, middle nasal meatus, and urine of one patient each from other wards. Pulsed-field gel electrophoresis (PFGE) was performed to evaluate horizontal transmission. Molecular typing by PFGE showed that the 28 MRSA strains presented 7 patterns in total, and that 11 of the MRSA strains had the same PGFE pattern. Unselective use of intranasal mupirocin ointment, MRSA monitoring for new inpatients, and prevention of direct or indirect contact infection were performed. However, the number of inpatients with MRSA did not quickly decrease, and additional molecular typing by PFGE showed that 10 of 19 MRSA strains found (5 of 6 from blood, 5 of 13 from other specimens) were the same as those found previously. Lectures and ward rounds were performed repeatedly, and staff participation in ward rounds was suggested. Finally, the number of inpatients with MRSA significantly decreased more than 6 months after the intervention. Although the MRSA outbreak was thought to have ended, follow-up molecular typing by PFGE showed that horizontal transmission persisted. Our data suggest that various combinations of infection control measures are essential when dealing with an MRSA outbreak, and monitoring by molecular analysis using PFGE is useful to identify the status of the outbreak.
authors.affiliation: Division of Infectious Diseases, Department of Infectious Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan, hidaka_hidenobu@kurume-u.ac.jp.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Hidaka
authors.forename: Miho
authors.initials: M
authors.lastname: Miura
authors.forename: Kenji
authors.initials: K
authors.lastname: Masunaga
authors.forename: Liang
authors.initials: L
authors.lastname: Qin
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Uemura
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Sakai
authors.forename: Kouji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Sayuri
authors.initials: S
authors.lastname: Kawano
authors.forename: Norio
authors.initials: N
authors.lastname: Yamashita
authors.forename: Teruo
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
mesh_terms: D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007564:Japan / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058889:Molecular Typing / Q000379:methods*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D004269:DNA, Bacterial