Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T09:38:30.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Molecular and epidemiological analysis of methicillin-resistant Staphylococcus aureus otorrhoea: hospital- or community-acquired?

Published online by Cambridge University Press:  18 June 2010

R G Nassif ,
R Soliman ,
D H Edwards ,
N Kara  and
S S M Hussain
R G Nassif*
Affiliation:
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
R Soliman
Affiliation:
Department of Medical Microbiology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
D H Edwards
Affiliation:
Department of Medical Microbiology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
N Kara
Affiliation:
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
S S M Hussain
Affiliation:
Department of Otolaryngology, Ninewells Hospital and University of Dundee Medical School, Dundee, Scotland, UK
*
Address for correspondence: Mr Ramez George Nassif, Department of Otolaryngology, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK. Fax: +44 (0)1382 632816 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

(1) To identify newly diagnosed cases of methicillin-resistant Staphylococcus aureus ear infection in our local population; (2) to determine the risk factors involved in these patients' clinical courses, and (3) to type the bacterial strains isolated and thus identify whether they were hospital- or community-acquired.

Design and setting:

Retrospective review of case notes, together with laboratory-based molecular studies in the departments of otolaryngology and medical microbiology in a university teaching hospital in Scotland, UK.

Subjects:

Over a two-year period, 35 patients were identified with ear swabs positive for methicillin-resistant Staphylococcus aureus infection. These cases came from both hospital and community settings.

Main outcome measures:

(1) Identification of primary methicillin-resistant Staphylococcus aureus otorrhoea in patients with no previously documented colonisation; and (2) molecular typing of the strains isolated, using spa technology, to identify whether they were hospital- or community-acquired.

Results:

Of the 35 positive patients, 27 were previously known carriers of methicillin-resistant Staphylococcus aureus. The eight patients with newly diagnosed methicillin-resistant Staphylococcus aureus otorrhoea presented initially in the community. All of these patients had had contact with hospital staff (as in-patients or out-patients) in the weeks preceding development of their ear infection. Using the spa technique for molecular typing, we identified hospital-acquired (‘epidemic’) methicillin-resistant Staphylococcus aureus type 15 in all eight patients' isolates. All were sensitive to topical gentamicin.

Conclusions:

In our cohort, hospital-acquired methicillin-resistant Staphylococcus aureus type 15 was the commonest cause of methicillin-resistant Staphylococcus aureus otorrhoea, despite the fact that these patients all first presented in the community. We believe that contact with hospital staff or health care workers is a risk factor for acquiring methicillin-resistant Staphylococcus aureus otorrhoea in the community.

Keywords

MRSAExternal Auditory CanalOtorrhoeaHospital Acquired Infections
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 12 , December 2010 , pp. 1247 - 1250
Copyright
Copyright © JLO (1984) Limited 2010

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

1Ayliffe, GAJ. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1997;24(Suppl. 1):S74–9CrossRefGoogle ScholarPubMed
2Wang, JT, Chang, S, Ko, WK. A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier. J Hosp Infect 2001;47:110–15CrossRefGoogle ScholarPubMed
3Al-Shawwa, BA, Wegner, D. Trimethoprim-sulfamethoxazole plus topical antibiotics as therapy for acute otitis media with otorrhoea caused by community-acquired methicillin-resistant Staphylococcus aureus in children. Arch Otolaryngol Head Neck Surg 2005;13:782–4CrossRefGoogle Scholar
4Koreen, L, Ramaswamy, SV, Graviss, EA, Naidich, S, Musser, JM, Kreiswirth, BN. Spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro- and macro variation. J Clin Microbiol 2004;42:792–9CrossRefGoogle Scholar
5Malachowa, N, Sabat, A, Gniadkowski, M, Krzyszton-Russjan, J, Empel, J, Miedzobrodzki, J et al. Comparison of multiple-locus variable-number tandem-repeat analysis with pulsed-field gel electrophoresis, spa typing, and multilocus sequence typing for clonal characterization of Staphylococcus aureus isolates. J Clin Microbiol 2005;43:3095–100CrossRefGoogle ScholarPubMed
6Harmsen, D, Claus, H, Witte, W, Rothganger, J, Claus, H, Turnwald, D et al. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442–8CrossRefGoogle Scholar
7Von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteraemia. N Engl J Med 2001;344:11–16CrossRefGoogle Scholar
8Yeo, SG, Park, DC, Hong, SM, Cha, CI, Kim, MG. Bacteriology of chronic suppurative otitis media – a multicenter study. Acta Otol 2007;127:1062–7CrossRefGoogle ScholarPubMed
9Hwang, JH, Chu, C-K, Liu, TC. Changes in bacteriology of discharging ears. J Laryngol Otol 2002;116:686–9CrossRefGoogle ScholarPubMed
10Cotticchia, JM, Dohar, JE. Methicillin-resistant Staphylococcus aureus otorrhoea after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg 2005;131:868–73CrossRefGoogle Scholar
11Hunt, A, Robb, PJ. Successful treatment of MRSA otorrhoea: a case report. J Laryngol Otol 2006;120:63–4CrossRefGoogle ScholarPubMed
12Gillet, Y, Issartel, B, Vanhems, P, Fournat, JC, Lina, G, Bes, M et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leucocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2000;359:753–9CrossRefGoogle Scholar
13Nathwani, D, Morgan, M, Masterton, R, Dryden, M, Cookson, BD, French, G et al. , for the British Society for Antimicrobial Chemotherapy Working Party on Community-onset MRSA Infections. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother 2008;61:976–94CrossRefGoogle Scholar
14Hwang, JH, Tsai, HY, Liu, TC. Community-acquired methicillin resistant Staphylococcus aureus infection in discharging ears. Acta Otolaryngol 2002;122:827–30CrossRefGoogle ScholarPubMed
15Deurenberg, RH, Vink, C, Kalenic, S, Friedrich, AW, Bruggeman, CA, Stobberingh, E. The molecular evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2007;13:222–35CrossRefGoogle ScholarPubMed
16Frenay, HM, Bunschoten, AE, Schouls, LM, Van Leeuwen, WJ, Vandenbroucke-Grauls, CM, Mooi, FR. Molecular typing of methicillin-resistant Staphylococcus aureus on the basis of protein A gene polymorphism. Eur J Clin Microbiol Infect Dis 1996;15:60–4CrossRefGoogle ScholarPubMed
17Harmsen, D, Claus, H, Vogel, U. DNA sequence-based tandem repeat analysis of the clfB gene is less discriminatory than spa typing for methicillin-resistant Staphylococcus aureus. Int J Med Microbiol 2005;294:525–8CrossRefGoogle ScholarPubMed
18Saunders, JE, Raju, PR, Boone, J, Berryhill, W. Current bacteriology of suppurative otitis: resistant patterns and outcome analysis. Otology and Neurootology 2009;30:339–43CrossRefGoogle Scholar
19Yang, JA, Kim, JY, Yoon, YK, Kim, S, Park, DW, Sohn, JW et al. Epidemiological and genetic characterisation of methicillin-resistant Staphylococcus aureus isolates from the ear discharge of outpatients with chronic otitis media. J Korean Med Sci 2008;23:762–6CrossRefGoogle ScholarPubMed
20Mandell, GL, Bennett, JE, Dolin, R. Principles and Practice of Infectious Diseases. London: Churchill Livingstone, 2000;2069–92Google Scholar