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The Evolving Epidemiology of Methicillin-Resistant Staphylococcus aureus at a University Hospital

Published online by Cambridge University Press:  02 January 2015

Marcelle C. Layton ,
Walter J. Hierholzer Jr  and
Jan Evans Patterson
Marcelle C. Layton
Affiliation:
Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut
Walter J. Hierholzer Jr
Affiliation:
Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut Department of Epidemiology and Public Health, New Haven, Connecticut
Jan Evans Patterson*
Affiliation:
Department of Medicine, Section of Infectious Diseases, New Haven, Connecticut Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
*
Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7881
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Abstract

Objective:

To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at a university hospital during a 14-month period.

Design:

Prospective laboratory-based surveillance for MRSA with descriptive epidemiology based on medical chart review and characterization of strains by DNA typing, using pulsed-field gel electrophoresis (PFGE).

Setting:

An 850-bed tertiary care university hospital.

Patients:

Patients with clinical isolates of MRSA.

Main Outcome Measure:

Determination whether MRSA isolates were community- or hospital-related.

Results:

Among 87 patients with MRSA, 36 (41%) had community-acquired infections. Community acquisition was associated with recent hospitalization, previous antibiotic therapy, nursing home residence, and intravenous drug use. Greater than 3 months had elapsed from the time of discharge for 13 (62%) of the 21 patients with community-acquired isolates hospitalized within the last year. Eight patients (22%) with community-acquired MRSA had no discernible risk factors. PFGE allowed differentiation of 35 distinct whole-cell DNA patterns; heterogeneity was seen among both nosocomial and community-acquired isolates, with few instances of cross-transmission.

Conclusions:

Our data suggest an increase in community acquisition of MRSA. PFGE demonstrated heterogeneity of MRSA isolates from both the community and the hospital setting.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 1 , January 1995 , pp. 12 - 17
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995 

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References

1. Benner, EJ, Kayser, FH. Growing clinical significance of methicillin-resistant Staphylococcus aureus . Lancet 1968;2:741–744.Google Scholar
2. Boyce, JM, Causey, WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control 1982;3:377–383.Google Scholar
3. Mulligan, ME, Murray-Leisure, KA, Standiford, HC, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
4. Centers for Disease Control. Community-acquired methicillin-resistant Staphylococcus aureus infections-Michigan. MMWR 1981;30:185–187.Google Scholar
5. Levine, DP, Cushing, RD, Jui, J, Brown, WJ. Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit Medical Center. Ann Intern Med 1982;97:330–338.Google Scholar
6. Saravolatz, LD, Markowitz, N, Arking, L, Pohlod, D, Fisher, E. Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982;96:11–16.Google Scholar
7. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, TT. Methicillin-resistant Staphylococcus aureus in extended care facilities: experiences in a Veterans Affairs nursing home and a review of the literature. Infect Control Hosp Epidemiol 1991;12:3645.Google Scholar
8. Duncan, R, Greene, WH. Methicillin-resistant Staphylococcus aureus in intensive care units and a dermatology service. Presented at the Association for Practitioners in Infection Control 11th Annual Educational Conference: June 3-7. 1984; Washington, DC. Abstract 80.Google Scholar
9. Centers for Disease Control. Guidelines for the Prevention and Control of Nosocomial Infections. Atlanta, GA: U.S. Department of Health and Human Services; 1981.Google Scholar
10. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disc Susceptibility Tests. 4th ed. NCCLS;10:7;1990. M2-A4.Google Scholar
11. Archer, GL, Pennell, E. Detection of methicillin resistance by using a DNA probe. Antimicrob Agents Chemother 1990;34:1720–1724.Google Scholar
12. Smith, CL, Cantor, CR. Purification, specific fragmentation and separation of large DNA molecules. Methods Enzymol 1987;155:449–467.Google Scholar
13. Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbial 1990;28:2059–2063.Google Scholar
14. Layton, MC, Perez, M, Heald, P, Patterson, JE. An outbreak of mupirocin-resistant Staphylococcus aureus on a dermatology ward associated with an environmental reservoir. Infect Control Hosp Epidemiol 1993;14:369–375.Google Scholar
15. Dean, AG, Dean, JA, Burton, AH, Dicker, RC. Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Stone Mountain, GA: USD Inc; 1990.Google Scholar
16. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11:639–642.Google Scholar
17. Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221S–227S.Google Scholar
18. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.Google Scholar
19. Nettleman, MD, Trilla, A, Frederickson, M, Pfaller, M. Assigning responsibility: using feedback to achieve sustained control of methicillin-resistant Staphylococcus aureus . Am J Med 1991;91(supp1 3B):228S–232S.Google Scholar
20. Linneman, CC, Moore, P, Staneck, JL, Pfaller, MA. Reemergence of epidemic methicillin-resistant Staphylococcus aureus in a general hospital associated with changing staphylococcal strains. Am J Med 1991;91(3B):238S–244S.Google Scholar
21. Muder, RR, Brennan, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
22. Hsu, CCS, Macaluso, CP, Special, L, Hubble, R. High rate of methicillin resistance of Staphylococcus aureus isolated from nursing home patients. Arch Intern Med 1988;148:569–570.Google Scholar
23. Garner, JS, Jarvis, W, Emori, TG, Horan, TC, Hughes, JM. Centers for Disease Control definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
24. Muder, RR, Brennan, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
25. Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.Google Scholar
26. Jordens, JZ, Hall, LMC. Characterization of methicillin-resistant Staphylococcus aureus isolates by restriction endonuclease digestion of chromosomal DNA. J Med Microbial 1988;27:117–123.Google Scholar
27. Mulligan, ME, Arbeit, RD. Epidemiologic and clinical utility of typing systems for differentiating among strains of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 1991;12:20–28.Google Scholar
28. Fang, FC, McClelland, M, Guiney, DG, et al. Value of molecular epidemiologic analysis in a nosocomial methicillin-resistant Staphylococcus aureus outbreak. JAMA 1993;270:1323–1328.Google Scholar
29. Prevost, G, Pottecher, B, Dahlet, M, Bientz, M, Mantz, JM, Piemont, Y. Pulsed field gel electrophoresis as a new epidemiological tool for monitoring methicillin-resistant Staphylococcus aureus in an intensive care unit. J Hosp Infect 1991;17:255–269.Google Scholar
30. Ichiyama, S, Ohta, M, Shimokata, K, Kato, N, Takeuchi, J. Genomic DNA fingerprinting by pulsed-field gel electrophoresis as an epidemiological marker for study of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . J Clin Microbial 1991;29:2690–2695.Google Scholar
31. Wei, MQ, Wang, D, Grubb, WB. Use of contour-clamped homogeneous electric field (CHEF) electrophoresis to type methicillin-resistant Staphylococcus aureus . J Med Microbial 1992;36:172–176.Google Scholar