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Methicillin-Resistant Staphylococcus aureus in Extended-Care Facilities: Experiences in a Veterans Affairs Nursing Home and a Review of the Literature

Published online by Cambridge University Press:  21 June 2016

Larry J. Strausbaugh ,
Cleone Jacobson ,
David L. Sewell ,
Susan Potter  and
Thomas T. Ward
Larry J. Strausbaugh*
Affiliation:
Infectious Disease Section, Medical Service, Veterans' Affairs Medical Center, Portland, Oregon Division of Infectious Diseases, Department of Medicine, Oregon Health Sciences University, Portland, Oregon
Cleone Jacobson
Affiliation:
Nursing Service, Veterans' Affairs Medical Center, Portland, Oregon
David L. Sewell
Affiliation:
Laboratory Service, Veterans' Affairs Medical Center, Portland, Oregon Department of Pathology, School of Medicine, Oregon Health Sciences University, Portland, Oregon
Susan Potter
Affiliation:
Research Service, Veterans' Affairs Medical Center, Portland, Oregon
Thomas T. Ward
Affiliation:
Infectious Disease Section, Medical Service, Veterans' Affairs Medical Center, Portland, Oregon Division of Infectious Diseases, Department of Medicine, Oregon Health Sciences University, Portland, Oregon
*
(111F), Veterans' Affairs Medical Center, P.O. Box 1034, Portland, OR 97207
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Abstract

Objectives:

To delineate the spread of methicillin-resistant Staphylococcus aureus (MRSA) in a nursing home care unit (NHCU), determine its consequences, and discuss this experience in the context of reports fi-om other nursing homes.

Design:

Observational and descriptive; routine and special surveillance for MRSA, including a facility-wide prevalence survey; characterization of MRSA isolates by disk diffusion and agar diluation susceptibility studies and restriction enzyme analysis of plasmid (REAP) DNA.

Setting and Patients:

A 120-bed skilled nursing facility that is an integral part of the Veterans' Affairs Medical Center (VAMC), Portland, Oregon. The patients are predominantly elderly men with severe underlying diseases and functional impairments.

Results:

An asymptomatic carrier brought MRSA into the NHCU in December 1987. During the next 15 months, 24 additional MRSA cases were detected. A prevalence survey conducted in March 1989 indicated that 39 (34%) of the 114 patients and 8 (7%) of the 117 employees were colonized or infected with MRSA. All strains were resistant to ciprofloxacin. REAP DNA indicated that 37 of 41 strains recovered in the March survey had identical patterns. Although 16 episodes of MRSA infection occurred in NHCU residents during 1988 through 1989, the outbreak had little effect on overall patterns of infectious morbidity and mortality in the facility. The outbreak, however, did result in an increased MRSA caseload at the medical center's acute-care division.

Conclusions:

During the last three years, MRSA colonization and infection have become common in the NHCU at the Portland VAMC; this experience parallels that reported by several nursing homes in other parts of the country.

Type
Original article
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 1 , January 1991 , pp. 36 - 45
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Williams, JW Jr, Wenzel, RP. Coping with methicillin-resistant S aureus infections. The Journal of Critical Illness. 1987;65–68.Google Scholar
2. Brumfitt, W, Hamilton-Miller, J. Methicillin-resistant Staphylococcus aureus . N Engl J Med. 1989:320:1188–1196.CrossRefGoogle ScholarPubMed
3. Boyce, JM. Methicillin-resistant Staphylococcus aureus: detection epidemiology and control measures. Infect Dis Clin North Am. 1989;3:901–913.CrossRefGoogle ScholarPubMed
4. O'Toole, RD, Drew, WL, Dahlgren, BJ, et al. An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA. 1970:213:257–263.CrossRefGoogle ScholarPubMed
5. Storch, GA, Radcliff, JL, Meyer, PL; Hinrichs, JH. Methicillin-resistant Staphylococcus aureus in a nursing home. Infect Control. 1987:8:24–29.CrossRefGoogle ScholarPubMed
6. Thomas, JC, Bridge, J, Waterman, S, Vogt, J, Kilman, L, Hancock, G. Transmission and control of methicillin-resistant Staphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol. 1989;10:106–110.CrossRefGoogle Scholar
7. Hsu, CCS, Macaluso, CP, Special, L, Hubble, RH. High rate of methicillin resistance of Staphylococcus aureus isolated from hospitalized nursing home patients. Arch Intern Med.1988;148:569–570.CrossRefGoogle ScholarPubMed
8. Cederna, JE, Terpenning, MS, Ensberg, M, Bradley, SF, Kauffman, CA. Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin. Infect Control Hosp Epidemiol. 1990:11:13–16.CrossRefGoogle Scholar
9. Jacobson, C, Strausbaugh, LJ. Incidence and impact of infection in a nursing home care unit. Am J Infect Control.1990;18:151–159.CrossRefGoogle Scholar
10. Lennette, EH, Balows, A, Hauser, WJ Jr, Shadomy, HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology:1985.Google Scholar
11. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 4th ed. Villanova, Pa: NCCLS; 1990:M2–A4.Google Scholar
12. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 2nd ed. Villanova, Pa: NCCLS; 1990:M7–A2.Google Scholar
13. Townsend, DE, Ashdown, N, Bolton, S, Grubb, WB. The use of cetyltrimethylammonium bromide for the rapid isolation from Staphylococcus aureus of relaxable and nonrelaxed plasmid DNA suitable for in vitro manipulation. Otters in Applied Microbiology.1985;1:87–94.CrossRefGoogle Scholar
14. Hartstein, AI, Morthland, VH, Eng, S, et al. Restriction enzyme analysis of plasmid DNA and bacteriophage typing of paired Staphylococcus aureus blood culture isolates. J Clin Microbiol. 1989;27:1874–1879.CrossRefGoogle ScholarPubMed
15. Garner, JS, Simmons, BP. Guideline for isolation precautions in hospitals. Infect Control. 1983;4:245–325.Google ScholarPubMed
16. Lynch, P, Jackson, PN, Cummings, FD, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med. 1987;107:243–246.CrossRefGoogle ScholarPubMed
17. Strausbaugh, LJ, Jacobson, CM, Sewell, DL, Ward, TT Antimicrobial therapy for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in residents and staff of a nursing home care unit (NHCU). 90th Annual Meeting American Society for Microbiology. May 13-17. 1990. Anaheim. Calif: American Society for Microbiology; Abstract L13.Google Scholar
18. Wakefield, DS, Pfaller, M, Massanari, RM, Hammons, GT Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control. 1987;8:151–156.CrossRefGoogle ScholarPubMed
19. Preheim, LC, Rimland, D, Bittner, MJ. Methicillin-resistant Staphylococcus aureus in Veterans Administration Medical Centers. Infect Control. 1987;8:191–193.CrossRefGoogle ScholarPubMed
20. Gupta, A, Hancock, J, Enos, WF, et al. Nursing homes in Northern Virginia are reservoir for methicillin-resistant Staphylococcus aureus (MRSA). 90th Annual Meeting American Societyfor Microbiology, May 13-17, 1990. Anaheim, Calii American Society for Microbiology; Abstract L-12.Google Scholar
21. Maple, PAC, Hamilton-Miller, JMT; Brumfitt, W. World-wide antibiotic resistance in methicillin-resistant Staphylococcus aureus . Lancet.1989;1:537–540.CrossRefGoogle ScholarPubMed
22. Shalit, I, Berger, SA, Gorea, A, Frimerman, H. Widespread quinolone resistance among methicillin-resistant Staphylococci aureus isolates in a general hospital. Antimicrob Agents Chemother. 1989;33:593–594.CrossRefGoogle Scholar
23. Shaefler, S. Methicillin-resistant strains of Staphylococcus aureus resistant to quinolones. J Clin Microbiol. 1989;27:335–336.CrossRefGoogle Scholar
24. Peterson, L, Quick, J, Jensen, B, et al. Emergence of ciprofloxacin resistance in nosocomial methicillin-resistant Staphylococcus aureus (MRSA) isolates during ciprofloxacin plus rifampin therapy for MRSA colonization. 29th interscience Conference for Antimicrobial Agents and Chemotherapy, Septemberl7-20,1989. Houston, Tx: American Society for Microbiology; Abstract 1255.Google Scholar
25. Mulligan, ME, Ruane, PJ, Johnston, L, et al. Ciprofloxacin for eradication of methicllin-resistant Staphylococcus aureus colonization. Am J Med.1987;82(suppl 4A):215–219.Google Scholar
26. Piercy, EA, Barbara, D, Luby, JP, MacKowiak, PA. Ciprofloxacin for methicillin-resistant Staphylococcus aureus infections. Antimicrob Agents Chemother. 1989;33:128–130.CrossRefGoogle ScholarPubMed
27. Smith, SM, Eng, RHK, Tecson-Tuman, F. Ciprofloxacin therapy for methicillin-resistant Staphylococcus aureus infections or colonizations. Antimicrob Agents Chemother. 1989;33:181–184.CrossRefGoogle ScholarPubMed
28. McManus, AT, Mason, AD, McManus, WF, Pruitt, BA Jr. What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? Arch Surg. 1989;124:1456–1459.CrossRefGoogle Scholar
29. Standiford, HC. Methicillin-resistant Staphylococcus aureus infections: it's time to get tough. Infect Control. 1987;8:187–189.CrossRefGoogle ScholarPubMed
30. Crossley, K, Henry, K, Irvine, P, et al. Antibiotic use in nursing homes: prevalence, cost and utilization review. Bull NY Acad Med.1987;63:510–518.Google ScholarPubMed
31. Weinsten, RA. Resistant bacteria and infection control in the nursing home and hospital. Bull NY Acad Med. 1987;63:337–344.Google Scholar
32. Zimmer, JG, Bentley, DW, Valenti, WM, et al. Systemic antibiotic use in nursing homes-a quality assessment. J Am Geriatr Soc. 1986;34:703–710.CrossRefGoogle Scholar
33. Katz, PR, Beam, TR, Brand, F, Boyce, K. Antibiotic use in the nursing home: physician practice patterns. Arch Intern Med. 1990;150:1465–1468.CrossRefGoogle ScholarPubMed