Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has recently been reported to emerge in the community setting. We describe the investigation and control of a community-acquired outbreak of MRSA skin infections in a closed community of institutionalized adults with developmental disabilities. In a 9-month period in 1997, 20 (71%) of 28 residents had 73 infectious episodes. Of the cultures, 60% and 32% obtained from residents and personnel, respectively, grew S. aureus; 96% and 27% were MRSA. All isolates were genetically related by pulsed-field gel electrophoresis and belonged to a phage type not previously described in the region. No known risk factors for MRSA acquisition were found. However, 58 antibiotic courses had been administered to 16 residents during the preceding 9 months. Infection control measures, antibiotic restriction, and appropriate therapy resulted in successful termination of this outbreak. Selective antibiotic pressure may result in the emergence, persistence, and dissemination of MRSA strains, causing prolonged disease.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) has recently been reported to emerge in the community setting
The terms and definitions related to communityacquired MRSA remain controversial, and the “community” as a milieu for MRSA acquisition cannot be implicated with a high degree of certainty
During 1997, we investigated an outbreak of skin and soft-tissue infection involving MRSA in a closed community of institutionalized adults with developmental disabilities
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) has recently been reported to emerge in the community setting. We describe the investigation and control of a community-acquired outbreak of MRSA skin infections in a closed community of institutionalized adults with developmental disabilities. During 1997, we investigated an outbreak of skin and soft-tissue infection involving MRSA in a closed community of institutionalized adults with developmental disabilities. MRSA emerged and disseminated in this setting as a result of an extreme selective pressure exacerbated by heavy and continuous use of ineffective antimicrobial drugs. That such selective pressure was sufficient to promote MRSA emergence in the community underlines the threat associated with current antibiotic prescribing practices in the community
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