Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-06T06:49:44.877Z Has data issue: false hasContentIssue false
  • English
  • Français

An Outbreak of Heterogeneous Glycopeptide-Intermediate Staphylococcus aureus Related to a Device Source in an Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Sylvie Parer ,
Anne Lotthé ,
Patrick Chardon ,
Rosie Poncet ,
Hélène Jean-Pierre  and
Estelle Jumas-Bilak
Sylvie Parer
Affiliation:
Département d'Hygiène Hospitalière, Centre Hospitaller Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 5119 (Université Montpellier 2, Centre National de la Recherche Scientifique [CNRS], Institut de Recherche pour le Développement [IRD], Institut Français de Recherche pour l'Exploitation de la Mer [IFREMER], Université Montpellier 1), équipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France
Anne Lotthé
Affiliation:
Département d'Hygiène Hospitalière, Centre Hospitaller Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 5119 (Université Montpellier 2, Centre National de la Recherche Scientifique [CNRS], Institut de Recherche pour le Développement [IRD], Institut Français de Recherche pour l'Exploitation de la Mer [IFREMER], Université Montpellier 1), équipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France
Patrick Chardon
Affiliation:
Département d'Anesthésie et Réanimation A, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
Rosie Poncet
Affiliation:
Service de Médecine du Travail, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
Hélène Jean-Pierre
Affiliation:
Unité Mixte de Recherche 5119 (Université Montpellier 2, Centre National de la Recherche Scientifique [CNRS], Institut de Recherche pour le Développement [IRD], Institut Français de Recherche pour l'Exploitation de la Mer [IFREMER], Université Montpellier 1), équipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
Estelle Jumas-Bilak*
Affiliation:
Département d'Hygiène Hospitalière, Centre Hospitaller Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 5119 (Université Montpellier 2, Centre National de la Recherche Scientifique [CNRS], Institut de Recherche pour le Développement [IRD], Institut Français de Recherche pour l'Exploitation de la Mer [IFREMER], Université Montpellier 1), équipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France
*
UMR 5119, Equipe Pathogènes et Environnements, 15 Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

The emergence of Staphylococcus aureus with reduced susceptibility to glycopeptides (glycopeptide-intermediate S. aureus [GISA] and heterogeneous GISA [h-GISA]) leads to intensive care unit (ICU) outbreaks that frequently result in ward closure. We investigated the role of hospital hygiene in the transmission and eradication of an h-GISA outbreak.

Design.

The study is a description of an original environmental investigation around a series of 12 cases.

Setting and Patients.

The outbreak occurred in a 20-bed polyvalent/trauma ICU in a 2,800-bed tertiary care university hospital in France.

Interventions.

Specimens were obtained for surveillance and diagnostic cultures from all patients in the unit. Surface sampling was also performed. Geographic cohorting, contact isolation, emphasis on adherence to infection control practices, and environmental cleaning were implemented.

Results.

Twelve patients with h-GISA infection (n = 5) or colonization (n = 7) were identified. The mean interval between admission and h-GISA detection was 23.6 days (range, 10–89 days), with a median of 16.5 days. Environmental investigation identified an unexpected reservoir, namely, SpO2 sensors. The outbreak was controlled by a combination of measures, including eradication of this reservoir, avoiding total ward closure.

Conclusions.

Targeted surface sampling helps to secure the environment through active investigation of various reservoirs while maintaining normal activity on the ward. In our study, this method led to the detection of an unsuspected reservoir, the eradication of which helped control the h-GISA epidemic. Further applications of this original investigative procedure should allow confirmation of its relevance and efficiency.

Infect Control Hosp Epidemiol 2012;33(2):167-174

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 167 - 174
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gastmeier, P, Stamm-Balderjahn, S, Hansen, S, et al. Where should one search when confronted with outbreaks of nosocomial infection? Am J Infect Control 2006;34(9):603–605.CrossRefGoogle ScholarPubMed
2.Rashid, A, Solomon, LK, Lewis, HG, Khan, K. Outbreak of epidemic methicillin-resistant Staphylococcus aureus in a regional burns unit: management and implications. Burns 2006;32(4):452–457.CrossRefGoogle Scholar
3.Dryden, M, Parnaby, R, Dailly, S, et al. Hydrogen peroxide vapour decontamination in the control of a polyclonal meticillin-resistant Staphylococcus aureus outbreak on a surgical ward. J Hosp Infect 2008;68(2):190–192.Google Scholar
4.Tenover, FC, Biddle, JW, Lancaster, MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerg Infect Dis 2001;7(2):327–332.Google Scholar
5.Hiramatsu, K, Hanaki, H, Ino, T, Yabuta, K, Oguri, T, Tenover, FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40(1):135–136.Google Scholar
6.Hiramatsu, K, Aritaka, N, Hanaki, H, et al. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997;350(9092):1670–1673.CrossRefGoogle ScholarPubMed
7.Haraga, I, Nomura, S, Fukamachi, S, et al. Emergence of vancomycin resistance during therapy against methicillin-resistant Staphylococcus aureus in a burn patient: importance of low-level resistance to vancomycin. Int J Infect Dis 2002;6(4):302–308.CrossRefGoogle Scholar
8.Center for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin in the United States, 1997. Morb Mortal Wkly Rep 1997;46(35):813–815.Google Scholar
9.Bierbaum, G, Fuchs, K, Lenz, W, Szekat, C, Sahl, H-G. Presence of Staphylococcus aureus with reduced susceptibility to vancomycin in Germany. Eur J Clin Microbiol Infect Dis 1999;18(10):691–696.CrossRefGoogle ScholarPubMed
10.Ploy, MC, Grélaud, C, Martin, C, de Lumley, L, Denis, F. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital. Lancet 1998;351(9110):1212.CrossRefGoogle Scholar
11.Garnier, F, Chainier, D, Walsh, T, et al. A 1 year surveillance study of glycopeptide-intermediate Staphylococcus aureus strains in a French hospital [published erratum appears in J Antimicrob Chemother 2006;57(3):583]. J Antimicrob Chemother 2006;57(1):146–149CrossRefGoogle Scholar
12.Howden, BP, Davies, JK, Johnson, PDR, Stinear, TP, Grayson, L. Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev 2010;23(1):99–139.Google Scholar
13.Fridkin, SK. Vancomycin-intermediate and -resistant Staphylococcus aureus: what the infectious disease specialist needs to know. Clin Infect Dis 2001;32(1):108–115.Google Scholar
14.Pina, P, Marliere, C, Vandenesch, F, Bedos, J-P, Etienne, J, Allouch, P-Y. An outbreak of Staphylococcus aureus strains with reduced susceptibility to glycopeptides in a French general hospital. Clin Infect Dis 2000;31(5):1306–1308.CrossRefGoogle Scholar
15.Sakoulas, G, Moise-Broder, PA, Schentag, J, Forrest, A, Moellering, RC, Eliopoulos, GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2004;42(6):2398–2402.Google Scholar
16.Neoh, H-m, Hori, S, Komatsu, M, et al. Impact of reduced vancomycin susceptibility on the therapeutic outcome of MRSA bloodstream infections. Ann Clin Microbiol Antimicrob 2007;6:13, doi:10.1186/1476-0711-6-13.Google Scholar
17.de Lassence, A, Hidri, N, Timsit, J-F, et al. Control and outcome of a large outbreak of colonization and infection with glycopeptide-intermediate Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2006;42(2):170–178.Google Scholar
18.Guerin, F, Buu-Hoï, A, Mainardi, J-L, et al. Outbreak of methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides in a Parisian hospital. J Clin Microbiol 2000;38(8):2985–2988.Google Scholar
19.Soussy, CJ, Carret, G, Cavallo, JD, et al. Antibiogram Committee of the French Microbiology Society. Report 2000–2001 [in French]. Pathol Biol (Paris) 2000;48(9):832–871.Google Scholar
20.Corne, P, Marchandin, H, Jonquet, O, Campos, J, Bañuls, A-L. Molecular evidence that nasal carriage of Staphylococcus aureus plays a role in respiratory tract infections of critically ill patients. J Clin Microbiol. 2005;43(7):3491–3493.Google Scholar
21.Cartolano, GL, Cheron, M, Benabid, D, Leneveu, M, Boisivon, A, Association of Hospital Bacteriologists Virologists and Hygiene Professionals. Methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to glycopeptides (GISA) in 63 French general hospitals. Clin Microbiol Infect 2004;10(5):448–451.Google Scholar
22.Appelbaum, PC. Reduced glycopeptide susceptibility in methicillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 2007;30(5):398–408.Google Scholar
23.Macrae, MB, Shannon, KP, Rayner, DM, Kaiser, AM, Hoffman, PN, French, GL. A simultaneous outbreak on a neonatal unit of two strains of multiply antibiotic resistant Klebsiella pneumoniae controllable only by ward closure. J Hosp Infect 2001;49(3):183–192.Google Scholar
24.Nilsson, P, Ripa, T. Staphylococcus aureus throat colonization is more frequent than colonization in the anterior nares. J Clin Microbiol 2006;44(9):3334–3339.Google Scholar
25.Buehlmann, M, Frei, R, Fenner, L, Dangel, M, Fluckiger, U, Widmer, AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008;29(6):510–506.CrossRefGoogle ScholarPubMed
26.Warren, D, Guth, R, Coopersmith, C, Merz, L, Zack, J, Fraser, V. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol 2006;27(10):1032–1040.Google Scholar
27.Liu, C, Chambers, HF. Staphylococcus aureus with heterogeneous resistance to vancomycin: epidemiology, clinical significance, and critical assessment of diagnostic methods. Antimicrob Agents Chemother 2003;47(10):3040–3045.Google Scholar
28.Maor, Y, Rahav, G, Belausov, N, Ben-David, D, Smollan, G, Keller, N. Prevalence and characteristics of heteroresistant vancomycin-intermediate Staphylococcus aureus bacteremia in a tertiary care center. J Clin Microbiol 2007;45:(5)1511–1514.CrossRefGoogle ScholarPubMed
29.Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities [published erratum appears in N Engl J Med 2005;352(22):2362]. N Engl J Med 2005;352(14):1436–1444.CrossRefGoogle Scholar
30.French, GL, Otter, JA, Shannon, KP, Adams, NMT, Watling, D, Parks, MJ. Tracking contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57(1):31–37.Google Scholar
31.Huang, SS, Datta, R, Piatt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166(18):1945–1951.CrossRefGoogle ScholarPubMed
32.Hansen, S, Stamm-Balderjahn, S, Zuschneid, I, et al. Closure of medical departments during nosocomial outbreaks: data from a systematic analysis of the literature. J Hosp Infect 2007;65(4):348–353.Google Scholar