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Eradication of an epidemic methicillin-resistant Staphylococcus aureus (MRSA) from a geriatric university hospital: evidence from a 10-year follow-up

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Abstract

We report on a successful eradication of methicillin-resistant S. aureus (MRSA) after an epidemic in 1992 in the geriatric ward of a tertiary-care hospital. After identification of MRSA in seven patients, all patients and staff members in the geriatric ward underwent screening. A multifaceted intervention plan was implemented: contact isolation, optimization of infection control and decolonization of all MRSA carriers. Thirty-two patients and five staff members were found to be MRSA carriers. Twenty one of 32 (66%) patients and all five staff members were successfully decolonized. Seven of 32 (22%) patients died during the epidemic before decolonization. A couple was discharged with persisting MRSA colonization and two individuals were lost to follow-up. The eradication of the epidemic clone was proven by systematic screenings in 1995 and 1997. Since then, the strain has no longer been identified in our institution, based on epidemiological surveillance and molecular typing of all MRSA strains obtained from any specimen. This study provides strong evidence that long-term eradication of an MRSA epidemic in a hospital is feasible, and endemicity of MRSA after an outbreak can be avoided. The successful bundle approach for eradication of MRSA during an epidemic is expensive, but the long-term benefits likely outweigh the initial heavy use of resources.

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References

  1. Jevons MP, Coe AW, Parker MT (1963) Methicillin resistance in staphylococci. Lancet 1(7287):904–907

    Article  Google Scholar 

  2. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK (2007) Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 298(15):1763–1771

    Article  CAS  PubMed  Google Scholar 

  3. Tiemersma EW, Bronzwaer SL, Lyytikainen O, Degener JE, Schrijnemakers P, Bruinsma N, Monen J, Witte W, Grundman H (2004) Methicillin-resistant Staphylococcus aureus in Europe, 1999–2002. Emerg Infect Dis 10(9):1627–1634

    PubMed  Google Scholar 

  4. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA (2006) Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 355(7):666–674

    Article  CAS  PubMed  Google Scholar 

  5. Mertz D, Frei R, Jaussi B, Tietz A, Stebler C, Fluckiger U, Widmer AF (2007) Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 45(4):475–477

    Article  PubMed  Google Scholar 

  6. Wertheim HF, Vos MC, Boelens HA, Voss A, Vandenbroucke-Grauls CM, Meester MH, Kluytmans JA, van Keulen PH, Verbrugh HA (2004) Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect 56(4):321–325

    Article  CAS  PubMed  Google Scholar 

  7. Salmenlinna S, Lyytikainen O, Kotilainen P, Scotford R, Siren E, Vuopio-Varkila J (2000) Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Finland. Eur J Clin Microbiol Infect Dis 19(2):101–107

    Article  CAS  PubMed  Google Scholar 

  8. Goossens H, Ferech M, Vander Stichele R, Elseviers M (2005) Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 365(9459):579–587

    PubMed  Google Scholar 

  9. Fluckiger U, Widmer AF (1999) Epidemiology of methicillin-resistant Staphylococcus aureus. Chemotherapy 45(2):121–134

    Article  CAS  PubMed  Google Scholar 

  10. Harbarth S, Fankhauser C, Schrenzel J, Christenson J, Gervaz P, Bandiera-Clerc C, Renzi G, Vernaz N, Sax H, Pittet D (2008) Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 299(10):1149–1157

    Article  CAS  PubMed  Google Scholar 

  11. Kirkland KB, Weinstein JM (1999) Adverse effects of contact isolation. Lancet 354(9185):1177–1178

    Article  CAS  PubMed  Google Scholar 

  12. Bradley SF (1999) Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 106(5A):2S–10S, discussion 48S–52S

    Article  CAS  PubMed  Google Scholar 

  13. Kotilainen P, Routamaa M, Peltonen R, Oksi J, Rintala E, Meurman O, Lehtonen OP, Eerola E, Salmenlinna S, Vuopio-Varkila J, Rossi T (2003) Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 9(2):169–175

    PubMed  Google Scholar 

  14. Pastila S, Sammalkorpi KT, Vuopio-Varkila J, Kontiainen S, Ristola MA (2004) Control of methicillin-resistant Staphylococcus aureus outbreak involving several hospitals. J Hosp Infect 58(3):180–186

    Article  CAS  PubMed  Google Scholar 

  15. Simor AE, Augustin A, Ng J, Betschel S, McArthur M (1994) Control of MRSA in a long-term care facility. Infect Control Hosp Epidemiol 15(2):69–70

    Article  CAS  PubMed  Google Scholar 

  16. Kotilainen P, Routamaa M, Peltonen R, Evesti P, Eerola E, Salmenlinna S, Vuopio-Varkila J, Rossi T (2001) Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 161(6):859–863

    Article  CAS  PubMed  Google Scholar 

  17. Cederna JE, Terpenning MS, Ensberg M, Bradley SF, Kauffman CA (1990) Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin. Infect Control Hosp Epidemiol 11(1):13–16

    Article  CAS  PubMed  Google Scholar 

  18. Kauffman CA, Terpenning MS, He X, Zarins LT, Ramsey MA, Jorgensen KA, Sottile WS, Bradley SF (1993) Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment. Am J Med 94(4):371–378

    Article  CAS  PubMed  Google Scholar 

  19. Strausbaugh LJ, Jacobson C, Sewell DL, Potter S, Ward TT (1992) Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans Affairs nursing home care unit. Infect Control Hosp Epidemiol 13(3):151–159

    Article  CAS  PubMed  Google Scholar 

  20. Mertz D, Frei R, Periat N, Zimmerli M, Battegay M, Fluckiger U, Widmer AF (2009) Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med 169(2):172–178

    Article  PubMed  Google Scholar 

  21. National Committee for Clinical Laboratory Standards (1990) Performance standards for antimicrobial disc susceptibility tests. Approved standard M2-A4 (plus updates and informational supplements). National Committee for Clinical Laboratory Standards, Villanova, PA

  22. Fenner L, Widmer AF, Dangel M, Frei R (2008) Distribution of spa types among methicillin-resistant Staphylococcus aureus isolates during a 6 year period at a low-prevalence University Hospital. J Med Microbiol 57(Pt 5):612–616

    Article  PubMed  Google Scholar 

  23. Stranden A, Frei R, Widmer AF (2003) Molecular typing of methicillin-resistant Staphylococcus aureus: can PCR replace pulsed-field gel electrophoresis? J Clin Microbiol 41(7):3181–3186

    Article  CAS  PubMed  Google Scholar 

  24. Widmer AF, Conzelmann M, Tomic M, Frei R, Stranden AM (2007) Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol 28(1):50–54

    Article  PubMed  Google Scholar 

  25. Buehlmann M, Frei R, Fenner L, Dangel M, Fluckiger U, Widmer AF (2008) Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 29(6):510–516

    Article  CAS  PubMed  Google Scholar 

  26. Strommenger B, Braulke C, Heuck D, Schmidt C, Pasemann B, Nubel U, Witte W (2008) Spa typing of Staphylococcus aureus as a frontline tool in epidemiological typing. J Clin Microbiol 46(2):574–581

    Article  CAS  PubMed  Google Scholar 

  27. Loveday HP, Pellowe CM, Jones SR, Pratt RJ (2006) A systematic review of the evidence for interventions for the prevention and control of methicillin-resistant Staphylococcus aureus (1996–2004): report to the joint MRSA working party (subgroup A). J Hosp Infect 63(Suppl 1):S45–S70

    Article  PubMed  Google Scholar 

  28. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM (2003) SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 24(5):362–386

    Article  PubMed  Google Scholar 

  29. Casewell MW (1995) New threats to the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 30(Suppl):465–471

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Lukas Fenner, Microbiology Laboratory, University Hospital of Basel, for molecular characterization of the epidemic strain including spa-typing.

Previous presentation

A part of the data was presented as an abstract at the 6th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 1993, Seville, Spain, and an abstract was presented at the 19th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2009, Helsinki, Finland.

Funding

This study was supported in part by grant 3200BO-104179 from the Swiss National Science Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases & Hospital Epidemiology, University Hospital of Basel, Petersgraben 4, CH-4031, Basel, Switzerland

    D. Mertz, N. Periat, C. Scheidegger, M. Battegay & A. F. Widmer

  2. Microbiology Laboratory, University Hospital of Basel, Basel, Switzerland

    R. Frei

  3. Geriatric Hospitals, University Hospital of Basel, Basel, Switzerland

    W. Seiler

Authors
  1. D. Mertz
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  2. R. Frei
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  3. N. Periat
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  4. C. Scheidegger
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  5. M. Battegay
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  6. W. Seiler
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  7. A. F. Widmer
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Corresponding author

Correspondence to A. F. Widmer.

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Mertz, D., Frei, R., Periat, N. et al. Eradication of an epidemic methicillin-resistant Staphylococcus aureus (MRSA) from a geriatric university hospital: evidence from a 10-year follow-up. Eur J Clin Microbiol Infect Dis 29, 987–993 (2010). https://doi.org/10.1007/s10096-010-0955-6

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  • DOI: https://doi.org/10.1007/s10096-010-0955-6

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