Identification and control of an outbreak of ciprofloxacin-susceptible EMRSA-15 on a neonatal unit

J Hosp Infect. 2007 Nov;67(3):232-9. doi: 10.1016/j.jhin.2007.07.024. Epub 2007 Oct 22.

Abstract

We report the identification and control of an outbreak of a ciprofloxacin-susceptible strain of UK epidemic meticillin-resistant Staphylococcus aureus (EMRSA)-15 on a neonatal unit (NNU). All babies were screened for MRSA on admission using ciprofloxacin-containing media which did not detect the outbreak strain. The first identified case was a premature baby who developed MRSA bacteraemia with associated tibial osteomyelitis and multiple subcutaneous abscesses. The outbreak strain was subsequently identified in the nasopharyngeal secretions of a second child who was not clinically infected. Screening of all patients on the NNU using non-ciprofloxacin-media identified two other colonised babies. All four patient isolates were EMRSA-15, spa type t022, SCCmec IV, Panton-Valentine leucocidin (PVL) negative, indistinguishable by pulsed-field gel electrophoresis and susceptible to all non-beta-lactam antimicrobials tested. The outbreak strain was cultured from four of 48 environmental sites in a communal milk-expressing room. Unsupervised movement of mothers to and from the milk-expressing room may have contributed to the outbreak. Control measures included cohort isolation of affected babies, improved environmental cleaning, increased emphasis on hand hygiene and education of mothers. Ciprofloxacin-containing media should be used with caution for MRSA screening in settings where ciprofloxacin-susceptible strains (including community-associated MRSA) are increasing in prevalence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abscess / microbiology
  • Anti-Bacterial Agents / pharmacology*
  • Bacteremia / microbiology
  • Bacterial Typing Techniques
  • Bacteriological Techniques / methods
  • Carrier State / microbiology
  • Ciprofloxacin / pharmacology*
  • Cross Infection / diagnosis
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Culture Media / chemistry
  • Disease Outbreaks*
  • Drug Resistance, Bacterial*
  • Education
  • Environmental Microbiology
  • Erythromycin / pharmacology*
  • Female
  • Genotype
  • Hand Disinfection
  • Housekeeping, Hospital
  • Humans
  • Infant
  • Infant, Newborn
  • London / epidemiology
  • Microbial Sensitivity Tests
  • Nasopharynx / microbiology
  • Osteomyelitis / microbiology
  • Patient Isolation
  • Phenotype
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / isolation & purification

Substances

  • Anti-Bacterial Agents
  • Culture Media
  • Ciprofloxacin
  • Erythromycin