Brady Deirdre, Brennan Grainne, O'Connell Brian, Buckley Ruth, Brennan Marie, Lenehan Maria, Jerry Jincy, Nolke Lars, Javadpour Seyed Hossein, Hannan Margaret M, Lynch Breda, Lynch Maureen
Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
UCD School of Medicine, UCD Health Sciences Centre, University College Dublin, Dublin, Ireland.
Infect Prev Pract. 2024 Nov 15;7(1):100421. doi: 10.1016/j.infpip.2024.100421. eCollection 2025 Mar.
Patients undergoing cardiac surgery are identified as high risk for infection, including MRSA. An outbreak of MRSA was identified when two patients experienced MRSA infection concurrently in a cardiothoracic high dependency unit with uncommon detection of MRSA previously and an established screening programme.
An outbreak control team was convened and interventions applied including refresher training in hand and environmental hygiene, review of practice with regard to aseptic access of medical devices and consideration of antibiotic use in the unit. MRSA isolates were referred to the Irish National MRSA Reference Laboratory where typing assigned all isolates to t1597 and whole genome sequencing assigned them to multilocus sequence type ST72-MRSA-IV. Recovery of this strain from only this unit in Ireland and infrequent reporting in Europe prompted staff MRSA screening with two staff members found to harbour the outbreak strain. Despite successful decolonisation, recolonisation and further transmission to patients occurred.
In the clinical unit in which this outbreak occurred, the usual control measures to prevent spread of MRSA were in place. Recent Joint Healthcare Infection Society and Infection Prevention Society Guidance does not recommend routine staff screening for MRSA but does support its consideration in an outbreak of an unusual strain. In total, 9 patients and 2 staff were affected by this outbreak. There were 4 infections and 3 deaths. Sustained outbreak closure was necessary to protect certain national clinical programmes and was achievable only when colonised staff were no longer working in the unit.
接受心脏手术的患者被认定为感染高危人群，包括耐甲氧西林金黄色葡萄球菌（MRSA）感染。在一家心胸高依赖病房中，此前MRSA检出率很低且已有既定筛查方案，但仍有两名患者同时发生MRSA感染，由此确认发生了MRSA暴发。
召集了一个暴发控制小组并采取干预措施，包括手部和环境卫生方面的复习培训、医疗器械无菌操作的实践审查以及该病房抗生素使用情况的审议。MRSA菌株被送交爱尔兰国家MRSA参考实验室，分型结果显示所有菌株均属于t1597型，全基因组测序结果将它们归类为多位点序列类型ST72-MRSA-IV。在爱尔兰仅该病房发现了这种菌株，且在欧洲报告很少，这促使对工作人员进行MRSA筛查，结果发现两名工作人员携带暴发菌株。尽管成功进行了去定植，但仍发生了再定植并进一步传播给患者。
在此次暴发发生的临床病房，已采取了预防MRSA传播的常规控制措施。近期联合医疗保健感染学会和感染预防学会指南不建议对工作人员进行MRSA常规筛查，但支持在出现不寻常菌株暴发时考虑进行筛查。此次暴发总共影响了9名患者和2名工作人员。有4例感染，3例死亡。为保护某些国家临床项目，必须持续控制暴发，只有当携带定植菌的工作人员不再在该病房工作时才能实现。
