Mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA) and vascular surgery
An outbreak of mupirocin and methicillin resistant Staphylococcus aureus (MR-MRSA) occurred in a tertiary hospital, causing considerable disruption in a vascular unit. We investigated factors that might explain this large outbreak and areas for intervention to prevent a recurrence.
Cases of MRSA strain, spa type t127 or t922, were identified through databases, and healthcare records to describe affected patients in time, place and person. The adjusted matched odds ratio (amOR) for selected exposures in a matched case control study among hospital in-patients was calculated, using multivariable conditional logistic regression.
Forty-one cases occurred over 18 months. Males predominated (78%), with a median age of 73 years. The specialty with the largest number of patients was vascular surgery with 18 cases (44%). Male sex (amOR=21; 95%CI 0.99-454), vascular surgery consultation (amOR=5.1; 95%CI 0.89-29), urinary catheterisation (amOR=12; 95%CI 0.98-154), occupational therapy (amOR=9.9; 95%CI 1.6-61) and length-of-stay (amOR=1.1; 95%CI 1.0-1.1 per additional overnight stay) were independently associated with an outbreak case. Control measures included; enhanced contact precautions, patient isolation/cohorting, ward closure, enhanced environmental decontamination and staff screening.
Vascular patients and those with underlying high dependency, i.e. urinary catheterisation and a requirement for occupational therapy had a higher risk of colonisation with MR-MRSA. Recording patient dependency prospectively, avoiding excessive bed occupancy, and a formal hospital policy on staff MRSA screening, are recommended to prevent/control future outbreaks in vascular units and elsewhere in hospitals.
European Programme for Intervention Epidemiology Training (EPIET) fellowship from the European Centre for Disease Prevention and Control, Stockholm, Sweden.
CommentsThe original article is available at www.imj.ie
Published CitationGarvey P. et al. Mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA) and vascular surgery. Ir Med J. 2021;114(8):440
Publication DateSeptember 2021
- Beaumont Hospital
- Clinical Microbiology
PublisherIrish Medical Association
- Published Version (Version of Record)