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Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection.

Authors
  • Locksley, R M
  • Cohen, M L
  • Quinn, T C
  • Tompkins, L S
  • Coyle, M B
  • Kirihara, J M
  • Counts, G W
Type
Published Article
Journal
Annals of Internal Medicine
Publisher
American College of Physicians
Publication Date
Sep 01, 1982
Volume
97
Issue
3
Pages
317–324
Identifiers
PMID: 7114628
Source
Medline
License
Unknown

Abstract

A burn patient with a multiply antibiotic-resistant Staphylococcus aureus infection was transferred to Harborview Medical Center from a burn unit in another state. Despite standard wound precautions, transmission to 34 patients occurred during the subsequent 15 months. Twenty-seven of the patients were infected. Disease included pneumonia, empyema, bacteremia, endocarditis, osteomyelitis, and burn and wound infections. Seventeen of the 34 patients died. Phage typing and plasmid analysis showed the spread of multiply resistant S. aureus from the burn unit to the surgical intensive care unit where a study evaluating the use of chloramphenicol in cases of bowel sepsis was in progress. During this period the organism became resistant to chloramphenicol by acquiring either of two chloramphenicol R-plasmids. Using plasmid profiles and antibiograms, four epidemic strains were identified that assisted in identifying patient and personnel reservoirs. The outbreak was controlled only after rifampin was added to vancomycin treatment of infected patients, which correlated with eradication of the carrier state.

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