Outbreak of community-acquired methicillin-resistant Staphylococcus aureus skin infections among health care workers in a cancer center

• Published in: American journal of infection control Vol. 39; no. 2; pp. 112 - 117
• Main Authors: Kassis, Christelle, MD, Hachem, Ray, MD, Raad, Issam I., MD, Perego, Cheryl A., MT(ASCP), MPH, CIC, Dvorak, Tanya, BS, Hulten, Kristina G., PhD, Frenzel, Elizabeth, MD, MPH, Thomas, Georgia, MD, Chemaly, Roy F., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2011; Elsevier; Mosby-Year Book, Inc
• Subjects: Academic Medical Centers; Bacterial diseases; Biological and medical sciences; Chromosomes; Community-Acquired Infections - epidemiology; Disease Outbreaks; Disease transmission; Epidemics; Epidemiology. Vaccinations; Furunculosis - epidemiology; Furunculosis - microbiology; General aspects; health care workers; Health education; Health Personnel; Human bacterial diseases; Humans; Infection Control; Infectious Disease; Infectious Disease Transmission, Professional-to-Patient - statistics & numerical data; Infectious diseases; Medical personnel; Medical sciences; Methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; MRSA; outbreak; Questionnaires; Skin diseases; skin infection; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus infections; Texas - epidemiology; Texas; outbreak; health care workers; Methicillin-resistant Staphylococcus aureus; skin infection; MRSA; Epidemic; Check; Health care staff; Malignant tumor; Infection; Prevention; Community acquired infection; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Skin; Staphylococcal infection; Staphylococcus aureus; Cancer
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2010.04.220

Background The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) soft tissue infections is rising. However, CA-MRSA outbreaks among health care workers (HCWs) are rarely reported. We describe 3 clusters of CA-MRSA soft tissue infections among HCWs and the subsequent transmission to a patient. Methods The first cluster of boils occurred in 4 employees who worked in the ambulatory treatment clinic (area A) and 1 patient (PA1) who frequently visited area A. Three employees (EA1, EA2, and EA3) and PA1 had positive cultures. Twelve employees in 2 geographically separate diagnostic imaging areas (areas B and C) reported recent or current boils of whom EB1, EB2, EB3, and EC1 had positive cultures. Molecular subtyping using pulse-field gel electrophoresis (PFGE) was performed on all 8 isolates and confirmed by the Centers for Disease Control and Prevention laboratory. Results Relatedness of the MRSA strain was confirmed by PFGE in 7 of 8 isolates. Only EB3 was not related to the prototype CA-MRSA strain. All 7 related MRSA strains contained the typical genetic organization of staphylococcal cassette chromosome (SCC)- mec type IVa plus genes encoding Panton-Valentine Leukocidin. EB3’s strain contained SCC- mec type II and was Panton-Valentine Leukocidin negative. A total of 171 questionnaires was sent. Nine of the 85 HCWs who responded reported a recent or current history of boils. Infection control conducted an education program for employees in areas A, B, and C. Conclusion Early identification and control of CA-MRSA infections among HCWs is important to limit horizontal transmission to patients. Future efforts should include educational programs and guidelines for reporting and treating HCWs with MRSA infections.