A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16)

Objective. To determine the prevalence of Staphylococcus aureus strains among hospitalized patients at the beginning of their hospitalization and during their treatment and the resistance of strains to antibiotics, and to evaluate epidemiologic characteristics of these strains. Patients and methods. Sixty-one patients treated at the Department of Cardiac, Thoracic and Vascular Surgery were examined. Identification of Staphylococcus aureus strains was performed using plasmacoagulase and DNase tests. The resistance of Staphylococcus aureus to antibiotics, b-lactamase production, phagotypes, and phagogroups were determined. The isolated Staphylococcus aureus strains were tested for resistance to methicillin by performing disc diffusion method using commercial discs (Oxoid) (methicillin 5 mg per disk and oxacillin 1 mg per disk). Results. A total of 297 Staphylococcus aureus strains were isolated. On the first day of hospitalization, the prevalence rate of Staphylococcus aureus strains among patients was 67.3%, and it statistically significantly increased to 91.8% on days 7–10 of hospitalization (P<0.05). During hospitalization, patients were colonized with Staphylococcus aureus strains resistant to cephalothin (17.6% of patients, P<0.05), cefazolin (14.6%, P<0.05), tetracycline (15.0%, P<0.05), gentamicin (37.7%, P<0.001), doxycycline (30.7%, P<0.001), and tobramycin (10.6%, P>0.05). Three patients (4.9%) were colonized with methicillin-resistant Staphylococcus aureus strains, belonging to phage group II phage type 3A and phage group III phage types 83A and 77; 22.6– 25.5% of Staphylococcus aureus strains were nontypable. During hospitalization, the prevalence rate of phage group II Staphylococcus aureus strains decreased from 39.6% to 5.7% (P<0.05) and the prevalence rate of phage group III Staphylococcus aureus strains increased to 29.5% (P<0.001). Conclusions. Although our understanding of Staphylococcus aureus is increasing, well-designed communitybased studies with adequate risk factor analysis are required to elucidate further the epidemiology of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Surveillance of methicillin-resistant Staphylococcus aureus provides relevant information on the extent of the methicillin-resistant Staphylococcus aureus epidemic, identifies priorities for infection control and the need for adjustments in antimicrobial drug policy, and guides intervention programs.

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Analysis of methicillin-resistant Staphylococcus aureus by IS1181 profiling

Epidemiology and Infection ◽

10.1017/s0950268898008796 ◽

1998 ◽

Vol 120 (3) ◽

pp. 271-279 ◽

Cited By ~ 4

Author(s):

C. SYMMS ◽

B. COOKSON ◽

J. STANLEY ◽

J. V. HOOKEY

Keyword(s):

Staphylococcus Aureus ◽

Copy Number ◽

Type Strain ◽

Methicillin Resistant Staphylococcus Aureus ◽

Phage Type ◽

Cross Infection ◽

Insertion Element ◽

Methicillin Resistant ◽

Genomic Location ◽

Strain Nctc

Variation in the genomic location and copy number of the insertion element IS1181 in methicillin-resistant Staphylococcus aureus (MRSA) was investigated. Sixty-three isolates representing the Jevons type strain (NCTC 10442), phage-propagating strains, and epidemic strains were examined. A PCR amplicon of the insertion element was used to probe genomic restriction endonuclease digests. HindIII genomic digests gave 25 distinct IS1181 patterns, while EcoRI digests gave 20 patterns. EMRSA-01, -02, -04, -06, -07, -09, -10, -11, -13 and -14 contained the element but could not be subtyped by profiling it. EMRSA-16 did not contain IS1181, consistent with a unique evolutionary origin for this major UK epidemic strain. Marked heterogeneity was observed among isolates of EMRSA-03. Each EMRSA-03 strain examined gave a unique pattern, thereby allowing subtyping of an important epidemic phage type for the purposes of hospital cross-infection control.

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Contribution of a typing method based on IS256 probing of SmaI-digested cellular DNA to discrimination of European phage type 77 methicillin-resistant Staphylococcus aureus strains.

Journal of Clinical Microbiology ◽

10.1128/jcm.35.6.1415-1423.1997 ◽

1997 ◽

Vol 35 (6) ◽

pp. 1415-1423 ◽

Cited By ~ 9

Author(s):

A Morvan ◽

S Aubert ◽

C Godard ◽

N El Solh

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Phage Type ◽

Typing Method ◽

Methicillin Resistant ◽

Cellular Dna

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New phage type among methicillin-resistant Staphylococcus aureus associated with a local outbreak in Belgium during 2002

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2006.01516.x ◽

2006 ◽

Vol 12 (10) ◽

pp. 1036-1038 ◽

Cited By ~ 1

Author(s):

C. Wildemauwe ◽

C. Godard ◽

R. Joseph ◽

R. De Ryck ◽

A. Deplano ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Phage Type ◽

Methicillin Resistant

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Methicillin-Resistant Staphylococcus Aureus: Interstate Spread of Nosocomial Infections with Emergence of Gentamicin-Methicillin Resistant Strains

Infection Control ◽

10.1017/s0195941700052590 ◽

1980 ◽

Vol 1 (2) ◽

pp. 81-89 ◽

Cited By ~ 62

Author(s):

George Saroglou ◽

Margaret Cromer ◽

Alan L. Bisno

Keyword(s):

Staphylococcus Aureus ◽

Antimicrobial Agents ◽

Methicillin Resistant Staphylococcus Aureus ◽

Phage Type ◽

Bacterial Strains ◽

Methicillin Resistant ◽

Selective Pressures ◽

Potential Pathogen ◽

Resistant Strains ◽

Clinically Significant

AbstractA methicillin-resistant strain of Staphylococcus aureus (MRSA, phage type 84/85) was introduced into City of Memphis Hospital by a burn patient who had recently been treated for MRSA bacteremia in another institution 500 miles distant. Despite prompt recognition of the problem and institution of isolation procedures, six other patients developed secondary colonization during the ensuing six months, and five of these experienced clinically significant infections with MRSA. Three of the patients originally infected with MRSA, as well as two additional patients, subsequently developed colonization with staphylococcal strains of phage type 84/85 that were resistant to both methicillin and gentamicin (MRGRSA). Spread of the staphylococcal strains was most likely accomplished primarily via passive transfer from person to person. The hydrotherapy unit, which became contaminated with both MRSA and MRGRSA, may have played a secondary role. As illustrated by this outbreak, patients carrying potentially dangerous bacterial strains should be identified and informed of the problems posed by such carriage. It may be imprudent to admit such patients to hospitals that are free of the potential pathogen.The outbreak described here exemplifies a number of potential problems associated with control of nosocomial staphylococcal infections: (a) interhospital spread of methicillin-resistant strains; (b) secondary patient-to-patient intrahospital spread; and (c) emergence of even more resistant strains, possibly associated with selective pressures exerted by widespread use of broad-spectrum antimicrobial agents.

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