Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T06:55:08.782Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology of Methicillin-Resistant Staphylococcus aureus at a University Hospital in the Canary Islands

Published online by Cambridge University Press:  02 January 2015

Isabel Montesinos ,
Eduardo Salido ,
Teresa Delgado ,
Maria Lecuona  and
Antonio Sierra
Isabel Montesinos*
Affiliation:
Infection Control and Microbiology Department, Hospital Universitario de Canarias, Canary Islands, Spain
Eduardo Salido
Affiliation:
Research Unit, Hospital Universitario de Canarias, Canary Islands, Spain La Laguna University School of Medicine, Tenerife, Canary Islands, Spain
Teresa Delgado
Affiliation:
Infection Control and Microbiology Department, Hospital Universitario de Canarias, Canary Islands, Spain
Maria Lecuona
Affiliation:
Infection Control and Microbiology Department, Hospital Universitario de Canarias, Canary Islands, Spain
Antonio Sierra
Affiliation:
Infection Control and Microbiology Department, Hospital Universitario de Canarias, Canary Islands, Spain La Laguna University School of Medicine, Tenerife, Canary Islands, Spain
*
Servicio de Microbiología, Hospital Universitario de Canarias, Ofra s/n, La Cuesta, La Laguna S/C de Tenerife, Islas Canarias, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at a university hospital in Tenerife, Canary Islands, during a 40-month period and to evaluate the effectiveness of the application of control measures.

Design:

Laboratory-based surveillance, medical charts and microbiological records review, and characterization of strains by pulsed-field gel electrophoresis (PFGE) were used to describe the epidemiology. Infection control practices were introduced as an intervention.

Setting:

A 650-bed, tertiary-care university hospital.

Subjects:

Patients with clinical and nasal isolates of MRSA and colonized staff members.

Results:

The rate of nosocomial MRSA infections was 32.5% for 1997, 17.9% for 1998, 14.5% for 1999, and 25.6% during the first 4 months of 2000. The major sites of isolation for nosocomial MRSA infection included surgical wounds (25%) and the lower respiratory tract (24%). Intensive care units and surgical specialties had more frequent MRSA cases. Characteristics associated with nosocomial MRSA isolates included prior use of intensive antibiotic therapy, prolonged hospital stays, major underlying illness, invasive procedures, and older age. PFGE type A (subtype A1) was the strain most frequently found and the only PFGE type involved in clusters.

Conclusions:

Surveillance cultures and contact droplet precautions were followed by decreased rates for 2 years. Nevertheless, the spread of PFGE subtype Al to many different areas of the hospital and the increase in incidence during the first third of 2000 indicates either that surveillance cultures were not used widely enough or that compliance with isolation measures was suboptimal.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 9 , September 2003 , pp. 667 - 672
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Voss, A, Milatovic, D, Wallrauch-Schwarz, VT, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50–55.Google Scholar
2.Working Party of the British Society for Antimicrobial Chemotherapy and the Hospital Infection Society. Revised guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus in hospitals. J Hosp Infect 1998;39:253–290.Google Scholar
3.Garner, JS, Jarvis, WR, Emori, TG, Toran, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
4.Sheretz, RJ, Garibaldi, RAManosok, RD, et al.Consensus paper on the surveillance of surgical wound infections. Am J Infect Control 1992;20:263–270.Google Scholar
5.Murakami, K, Minamide, W, Wada, K, Nakamura, E, Teraoka, H, Watanabe, S. Identification of methicillin-resistant strains of staphylococci by polymerase chain reaction. J Clin Microbiol 1991;29:2240–2244.CrossRefGoogle ScholarPubMed
6.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 4th ed. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999. Approved standard M7-A4.Google Scholar
7.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests,> 6th ed. Wayne, PANational Committee for Clinical Laboratory Standards; 1999. Approved standard M2-A6.+6th+ed.+Wayne,+PANational+Committee+for+Clinical+Laboratory+Standards;+1999.+Approved+standard+M2-A6.>Google Scholar
8.Finlay, JE, Miller, LA, Poupard, JAInterpretative criteria for testing susceptibility of staphylococci to mupirocin. Antimicrob Agents Chemother 1997;41:1137–1139.Google Scholar
9.Gilbart, J, Perry, CR, Slocombe, B. High-level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-tRNA synthetases. Antimicrob Agents Chemother 1993;37:32–38.Google Scholar
10.Montesinos, I, Salido, E, Delgado, T, Cuervo, M, Sierra, AEpidemiologic genotyping of methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis at a university hospital and comparison with antibiotyping and protein A and coagulase gene polymorphisms. J Clin Microbiol 2002;40:2119–2125.Google Scholar
11.Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals: part II. Am J Infect Control 1996;24:32–52.Google Scholar
12.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
13.Veldhuijzen, I, Bronzwaer, S, Degener, J, Kool, J, EARSS Participants. European Antimicrobial Resistance Surveillance System (EARSS): susceptibility testing of invasive Staphylococcus aureus. Euro Surveill 2000;5:34–36.Google Scholar
14.Sopena, N, Sabriá, M, Pedro-Botet, ML, et al.Implantación de las medidas de control sobre la evolución de un brote epidémico por Staphylococcus aureus resistente a la meticilina. Med Clin (Bare) 1997;108:401–404.Google Scholar
15.Cercenado, E, Sanchez Carrillo, C, Alcalá, L, Bouza, E, Work Group on the Study of Staphylococcus. Current status of resistance of Staphylococcus in Spain: 4th national study (1996) [in Spanish]. Rev Clin Esp 1997;197(suppl 2):S12–S18.Google Scholar
16.Thompson, RI, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infection caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309–311.Google Scholar
17.Suh, K, Toye, B, Jessamine, RChan, F, Ramotar, K. Epidemiology of methicillin-resistant Staphylococcus aureus in three Canadian tertiary-care centers. Infect Control Hosp Epidemiol 1998;19:395–400.Google Scholar
18.Layton, MC, Hierholzer, WJ, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at the University Hospital. Infect Control Hosp Epidemiol 1995;16:12–17.Google Scholar
19.Johnson, Z, Fitzpatrick, P, Haynes, C, et al.National survey of MRSA: Ireland, 1995. J Hosp Infect 1997;35:175–184.Google Scholar
20.Wenzel, RP, Reagan, DR, Bertino, JS Jr, Baron, EJ, Arias, K. Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel's definition and management guidelines. Am J Infect Dis 1998;26:102–110.Google Scholar
21.Goldmann, DAWeinstein, RAWenzel, RP, et al.Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 1996;275:234–240.Google Scholar
22.Boyce, JM, Jackson, MM, Pugliese, G, et al.Methicillin-resistant Staphylococcus aureus: a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–115.Google Scholar
23.Boyce, JM. Strategies for controlling methicillin-resistant Staphylococcus aureus in hospitals. J Chemother 1995;7(suppl 3):81–85.Google ScholarPubMed
24.Parras, F, Guerrero, G. Importancia clínica de las infecciones causadas Staphylococcus aureus resistentes a la meticilina. Enferm Infecc Microbiol Clin 1992;10(suppl 3):S39–S42.Google Scholar
25.Morgan, M, Salmon, R, Keppie, N, Evans-Williams, D, Hosein, I, Looker, DN. All Wales surveillance of methicillin-resistant Staphylococcus aureus (MRSA): the first year's results. J Hosp Infect 1999;41:173–179.CrossRefGoogle ScholarPubMed
26.Peacock, JE, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.Google Scholar
27.Locksley, RM, Cohen, ML, Quinn, TC, et al.Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission and evolution of nosocomial infection. Ann Intern Med 1982;97:317–324.Google Scholar
28.Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides: epidemiological studies. J Infect Dis 1979;139:280–287.Google Scholar
29.Boyce, JM, Landry, M, Deetz, TR, Dupont, HL. Epidemiological studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981;2:110–116.Google Scholar
30.Parras, F, Rodriguez, M, Bouza, E, et al.Brote epidémico de Staphylococcus aureus resistente a meticilina en un hospital general: informe preliminar. Enferm Infecc Microbiol Clin 1991;9:200–207.Google Scholar
31.Gaspar, MC, Uribe, P, Sanchez, R, Coello, R, Cruzet, F. Personal sanitario portador nasal de Staphylococcus aureus resistente a la meticilina: utilidad del tratamiento con mupirocina. Enferm Infecc Microbiol Clin 1992;10:107–110.Google Scholar
32.Bacon, AE, Jorgensen, KAWilson, KH, Kauffman, CAEmergence of nosocomial methicillin-resistant and therapy of colonized personnel during hospital-wide outbreak. Infect Control 1987;8:145–150.Google Scholar
33.Cox, RAConquest, C. Strategies for management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect 1997;35:117–127.Google Scholar
34.Udo, EE, Jacob, LE, Mokadas, EM. Conjugative transfer of high-level mupirocin resistance from Staphylococcus haemolyticus to other staphylococci. Antimicrob Agents Chemother 1997;41:693–695.Google Scholar
35.Opal, SM, Mayer, KH, Stenberg, MJ, et al.Frequent acquisition of multiple strains of methicillin-resistant Staphylococcus aureus by healthcare workers in an endemic hospital environment. Infect Control Hosp Epidemiol 1990;11:479–485.Google Scholar
36.Reboli, AC, John, JF, Platt, CG, Cantey, JR. Methicillin-resistant Staphylococcus aureus outbreak at a Veteran's Affairs medial center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol. 1990;11:291–296.Google Scholar
37.Gaynes, R, Marosok, R, Mowry-Haley, J, et al.Mediastinitis following coronary-artery surgery: a 3-year review. J Infect Dis 1991;163:117–121.Google Scholar
38.Haley, RW, Hightower, AW, Khabbaz, RF, et al.The emergence of methicillin-resistant Staphylococcus aureus infection in United States hospitals: possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297–308.Google Scholar
39.Bartzokas, CAPanton, JH, Gibson, MF, Graham, R, McLoughlin, GACroton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med. 1984;311:1422–1424.Google Scholar
40.Mitsuda, T, Arai, K, Fujita, S, Yokota, S. Epidemiological analysis of strains of methicillin-resistant Staphylococcus aureus (MRSA) infection in the nursery: prognosis of MRSA carrier infants. J Hosp Infect 1995;31:123–134.Google Scholar
41.Meier, PACarter, CD, Wallance, SE, et al.A prolonged outbreak of methicillin-resistant Staphylococcus aureus in the burn unit of a tertiary medical center. Infect Control Hosp Epidemiol 1996;17:798–802.Google Scholar
42.Boyce, JM, Opal, SM, Potter-Bynoe, G, et al.Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Clin Infect Dis 1993;17:496–504.Google Scholar
43.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 Microbiol 1991;29:2690–2695.Google Scholar
44.Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1989;27:1471–1476.Google Scholar
45.Frénay, HME, Vanderbroucke-Grauls, CMJE, Molkenboer, MJCH, Verhoef, J. Long term carriage and transmission of methicillin-resistant Staphylococcus aureus after discharge from hospital. J Hosp Infect 1992;22:207–215.Google Scholar
46.Sandford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.Google Scholar
47.VandenBergh, MFQ, Yzerman, EPF, Van Belkum, ABoelens, HAM, Sijmons, M, Verbrugh, HA. Follow-up of Staphylococcus aureus nasal carriage after 8 years: redefining the persistent carrier state. J Clin Microbiol 1999;37:3133–3140.Google Scholar
48.Tenover, FC. Health care associated infections: moving beyond the hospital. Presented at the International Meeting on Bacterial Epidemiological Markers; September 2000; Amsterdam, the Netherlands.Google Scholar
49.Gaspar, MC, Sanchez, P, Uribe, P, Coello, R, Arroyo, P, Cruzet, F. Mupirocin susceptibility in vitro and nasal eradication of epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect 1993;24:237–238.Google Scholar
50.Cox, RA, Conquest, C, Mallagan, C, Marples, RRA major outbreak of methicillin-resistant Staphylococcus aureus caused by new phage-type (EMRSA-16). J Hosp Infect 1995;29:87–106.Google Scholar
51.Reagan, DR, Doebbeling, BN, Pfaller, MA, et al.Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.Google Scholar
52.Harbarth, S, Liassine, N, Dharan, S, Herrault, P, Auckenthaler, R, Pittet, D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000;31:1380–1385.Google Scholar
53.Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999;43:1412–1416.Google Scholar
54.Witte, W, Braulke, C, Heuck, D, Cuny, C. Methicillin-resistant Staphylococcus aureus in German hospitals develop narrower patterns of antimicrobial resistance. Euro Surveill 2000;5:31–34.Google Scholar
55.Miller, MADascal, A, Portnoy, J, Mendelson, J. Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996;17:811–813.Google Scholar
56.Netto dos Santos, KR, de Souza Fonseca, L, Gontijo Filho, PP. Emergence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from Brazilian University Hospitals. Infect Control Hosp Epidemiol 1996;17:813–816.Google Scholar
57.Centers for Disease Control and Prevention. Reduced susceptibility of Staphylococcus aureus to vancomycin: Japan, 1996. MMWR 1997;46:624–626.Google Scholar
58.Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin: United States, 1997. MMWR 1997;46:765–766.Google Scholar
59.Centers for Disease Control and Prevention. Update: Staphylococcus aureus with reduced susceptibility to vancomycin: United States, 1997. MMWR 1997;46:813–815.Google Scholar
60.Ploy, MC, Grelaud, C, Martin, C, Lumley, C, Denis, F. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital. Lancet 1998;351:1212.Google Scholar
61.Tenover, FC, Biddle, JW, Lancaster, MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerg Infect Dis 2001;7:327–332.Google Scholar
62.Prévost, G, Pottecher, B, Dahlet, M, Bientz, M, Mantz, JM, Piémont, 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
63.Prévost, G, Jaulhac, B, Piemont, Y. DNA fingerprinting by pulsed-field electrophoresis is more effective than ribotyping in distinguishing among methicillin-resistant Staphylococcus aureus isolates. J Clin Microbiol 1992;30:967–973.Google Scholar
64.Struelens, MJ, Deplano, A, Godard, C, Maes, N, Serruys, E. Epidemiological typing and delineation of genetic relatedness of methicillin-resistant Staphylococcus aureus by macrorestriction analysis of genomic DNA by using pulsed-field gel electrophoresis. J Clin Microbiol 1992;30:2599–2605.Google Scholar
65.Tenover, FC, Arbeit, R, Archer, G, et al.Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus. J Clin Microbiol 1994;32:407–415.CrossRefGoogle ScholarPubMed
66.Saulnier, P, Bourneix, C, Prévost, G, Andremont, A. Random amplified polymorphic DNA assay is less discriminant than pulsed-field gel electrophoresis for typing strains of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1993;31:982–985.Google Scholar
67.Schlichting, C, Branger, C, Fournier, JM, et al.Typing of Staphylococcus aureus by pulsed-field gel electrophoresis, zymotyping, capsular typing, phage typing: resolution of clonal relationships. J Clin Microbiol 1993;31:227–232.Google Scholar
68.Schmitz, FJ, Steiert, M, Tichy, HV, et al.Typing of methicillin-resistant Staphylococcus aureus isolates from Düsseldorf by six genotypie methods. J Med Microbiol 1998;47:341–351.Google Scholar
69.MacFarlane, L, Walker, J, Borrow, R, Oppenheim BA Fox, AJ. Improved recognition of MRSA case clusters by application of molecular subtyping using pulsed-field gel electrophoresis. J Hosp Infect 1999;41:29–37.Google Scholar
70.Roman, RS, Smith, J, Walker, M, et al.Rapid geographic spread of methicillin-resistant Staphylococcus aureus strain. Clin Infect Dis 1997;25:698–705.Google Scholar
71.Frénay, HME, Theelen, JPG, Schouls, LM, et al.Discrimination of epidemic and nonepidemic methicillin-resistant Staphylococcus aureus strains on the basis of protein A gene polymorphism. J Clin Microbiol 1994;32:846–847.Google Scholar