Murray R J, Pearson J C, Coombs G W, Flexman J P, Golledge C L, Speers D J, Dyer J R, McLellan D G, Reilly M, Bell J M, Bowen S F, Christiansen K J
Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Royal Perth Hospital, West Perth, Perth, Western Australia.
Infect Control Hosp Epidemiol. 2008 Sep;29(9):859-65. doi: 10.1086/590260.
To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner.
A medical practitioner's office and 4 hospitals in Perth, Western Australia.
Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner.
We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner.
Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified.
This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.
描述由一名医生进行经皮针刺操作（针灸和关节注射）后发生的耐甲氧西林金黄色葡萄球菌（MRSA）侵袭性感染暴发情况。
西澳大利亚州珀斯市的一名医生诊所及4家医院。
8名在接受该医生进行的针灸或关节注射后发生MRSA侵袭性感染的个体。
我们开展了一项前瞻性和回顾性暴发调查，包括MRSA定植监测、MRSA环境采样以及MRSA分离株的详细分子分型。我们对该医生的诊疗场所和操作进行了感染控制审核，并对该医生实施了MRSA去定植治疗。
共识别出8例MRSA侵袭性感染病例。7例为2004年5月的聚集性病例；另一例（回顾性识别）于2003年2月约15个月前发生。感染的主要部位为颈部、肩部、下背部和髋部：5例患者患有化脓性关节炎和滑囊炎，3例患有脓性肌炎；3例患者发生菌血症，其中1例可能患有心内膜炎。发现该医生在两个时间点携带相同的MRSA克隆[ST22-MRSA-IV（EMRSA-15）]：2003年3月首例感染后不久以及2004年5月再次携带。在对该医生的诊疗场所和操作进行审核且其本人接受MRSA去定植治疗后，未再发现新病例。
此次暴发很可能是由于经皮针刺操作过程中无菌技术失误，导致MRSA从医生传播至患者。本报告证明了监测和分子分型在识别和控制MRSA感染暴发中的重要性。
