Department of Clinical Microbiology, Nottingham University Hospital, Nottingham, UK.
Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, London, UK.
J Hosp Infect. 2014 Jan;86(1):42-6. doi: 10.1016/j.jhin.2013.10.006. Epub 2013 Oct 31.
Meticillin-sensitive Staphylococcus aureus (MSSA) is a frequent cause of surgical site infection (SSI), but point-source outbreaks are rarely recognized.
To describe an outbreak of MSSA SSI in a thoracic surgical unit.
An outbreak investigation was started following two postoperative bacteraemias with MSSA resistant to fusidic acid (MSSA FusR). Patients with MSSA FusR were identified from microbiology records and through prospective case finding. Healthcare workers (HCWs) were screened. Isolates were characterized by phage typing, spa typing, pulsed-field gel electrophoresis and toxin gene profiling. A case-control study examined the association between one HCW with MSSA FusR and the patients involved in the outbreak.
Nineteen patients were identified with MSSA FusR over 16 months. Four isolates were available for typing and all belonged to the same lineage. Seventy-six HCWs were screened. One was a carrier of the outbreak strain (a nurse with psoriasis). All 19 cases were exposed to this HCW compared with only 40/66 controls (P = 0.003) and cases had a greater duration of exposure (P = 0.00001, chi-squared for trend). Direct patient contact was documented in 15 cases. The outbreak was halted by thorough cleaning of the ward and removal of the HCW from clinical duty.
The HCW with psoriasis was the source of this outbreak. MSSA FusR may be a marker for strains associated with skin conditions. HCWs with significant skin conditions may pose an infection risk in surgical settings. Recommendations are made for occupational health teams regarding screening of HCWs with dermatitis.
耐甲氧西林金黄色葡萄球菌（MSSA）是手术部位感染（SSI）的常见病因，但很少能识别出定点源暴发。
描述胸外科病房耐万古霉素金黄色葡萄球菌（MSSA FusR）SSI 的暴发情况。
在出现两例耐万古霉素金黄色葡萄球菌（MSSA FusR）术后菌血症后，开始暴发调查。从微生物学记录和前瞻性病例发现中确定了 MSSA FusR 患者。对医护人员（HCWs）进行筛查。通过噬菌体分型、spa 分型、脉冲场凝胶电泳和毒素基因分析对分离株进行特征分析。病例对照研究调查了一位携带 MSSA FusR 的 HCW 与暴发相关患者之间的关联。
在 16 个月内发现 19 例耐万古霉素金黄色葡萄球菌 FusR 患者。有 4 株分离株可用于分型，均属于同一谱系。筛查了 76 名医护人员。其中一位是暴发株的携带者（一位患有牛皮癣的护士）。与仅 40/66 名对照者相比，所有 19 例病例均暴露于该 HCW（P = 0.003），并且病例的暴露时间更长（P = 0.00001，趋势性卡方检验）。在 15 例病例中记录了直接接触患者。通过彻底清洁病房和将 HCW 调离临床工作，暴发得到了控制。
患有牛皮癣的 HCW 是此次暴发的源头。耐万古霉素金黄色葡萄球菌 FusR 可能是与皮肤状况相关菌株的标志物。有明显皮肤状况的 HCWs 可能会给手术环境带来感染风险。建议为皮肤科医护人员制定体检筛查建议。
