Rahman M
Microbiology Department, King's Mill Hospital, Mansfield, Nottingham, UK.
Postgrad Med J. 1993;69 Suppl 3:S126-9; discussion S130.
A series of outbreaks of EMRSA occurred in three hospitals of a Health District in the years 1986 and 1987, affecting 64 patients and 6 staff members. By the antibiotic sensitivity pattern (methicillin-resistance and resistance to many others) and phage typing, the organism resembled the epidemic strains involved in London outbreaks. In this series of outbreaks, different circumstances led to adaptation of different control measures with their cost implications. As failure with chlorhexidine was experienced, it was replaced with povidone-iodine for routine handwashing and topical application to patients in affected wards. Heavy environmental contamination involving mattress, bed, floor, table, chair, locker, television etc. was shown. Repeated failures of a phenolic disinfectant led to use of formaldehyde or a higher concentration of the phenolic disinfectant which caused side effects in staff members. Various anti-bacterial agents had been used in treating different conditions in different cases. Mupirocin was found to be the best agent in treating infections or colonization of superficial accessible sites. For non-accessible sites fusidic acid and rifampicin were found to be satisfactory. Continued surveillance in the District for three years after the last case did not detect re-emergence of EMRSA.
1986年和1987年，某健康区的三家医院发生了一系列耐甲氧西林金黄色葡萄球菌（EMRSA）暴发事件，涉及64名患者和6名工作人员。根据抗生素敏感性模式（耐甲氧西林及对许多其他抗生素耐药）和噬菌体分型，该菌株与伦敦暴发事件中涉及的流行菌株相似。在这一系列暴发事件中，不同的情况导致采取了不同的控制措施及其成本影响。由于氯己定使用失败，改用聚维酮碘进行常规洗手，并用于受影响病房患者的局部应用。结果显示，床垫、床、地板、桌子、椅子、储物柜、电视等存在严重的环境污染。一种酚类消毒剂多次使用失败，导致使用甲醛或更高浓度的酚类消毒剂，这对工作人员产生了副作用。在不同病例的不同情况下使用了各种抗菌药物。发现莫匹罗星是治疗浅表易感染部位感染或定植的最佳药物。对于不易感染的部位，发现夫西地酸和利福平效果令人满意。在最后一例病例后，该地区持续监测三年，未发现EMRSA再次出现。
