ISSN : 2146-3123
E-ISSN : 2146-3131

Early Detection and Control of Methicillin Resistant Staphylococcus Aureus (MRSA) Outbreak in an Intensive Care Unit
Banu Bayraktar1, Alper Gündüz2, Erman Oryaşın3, Duygu Erdemir4, Leyla Teke1, Elif Aktaş1, Rıza Durmaz5, Selma Şen6, Nuray Uzun2, Bülent Bozdoğan7
1Clinical Microbiology Laboratory, Şişli Etfal Training and Research Hospital, Istanbul
2Infectious disease and Clinical Microbiology University of Health Sciences Şişli Etfal Training and Research Hospital
3Aydın Adnan Menderes University, Aydın, Turkey Recombinant DNA and Recombinant Protein Research Center (REDPROM)
4Becton, Dickinson and Company Becton, Dickinson and Company
5Microbiol. Reference Lab., Ankara, Turkey Clinical Microbiology Laboratory
6Sisli Hamidiye Etfal Training and Research Hospital Sisli Hamidiye Etfal Training and Research Hospital
7Merkez Kampüs Aydin Menderes University, Faculty of Medicine, Department of Medical Microbiology
DOI : 10.4274/balkanmedj.galenos.2020.2020.2.153

Background: Although Methicillin resistant Staphylococcus aureus (MRSA) is one of the major pathogens of healthcare associated infections, we had only sporadic cases in our intensive care unit (ICU) for years.
Aims: This study aims to investigate the sudden increase in the number of MRSA cases in ICU.
Study design: A descriptive study to investigate MRSA outbreak in an ICU and signify following standard precautions.
Methods: From the 5th of December 2016 to 26th January 2017, we detected 11 new MRSA cases in ICU. Screening of 73 ICU healthcare workers (HCWs) and screening of 13 patients was performed for outbreak investigation. Nine clinical isolates available in stocks and eight screening MRSA isolates were included in molecular studies. PFGE, Spa-mecA-mecC-pvl in-house multiplex PCR assay and spa typing, SCCmec typing were performed for all isolates. ST (Sequence type) clone type of representative strain was determined by Multi-Locus Sequence typing.
Results: All strains were positive for mecA gene, and have the same AST (Antimicrobial susceptibility testing) pattern. None of the strains were carrying pvl gene. All clinical, two patient screening and three nasal isolates of HCWs showed the same pulsotype (PT), named as clone A. Sequence type of these isolates is t030 and SCCmec type is SCCmecIII. Unrelated three isolates were having PFGE PT B-SCCmecI-t030, PFGE PT C-SCCmecIII-t459, PFGE PT D-SCCmecIII. MLST result showed that the outbreak strain belonged to ST239 clone.
Conclusion: The outbreak clone (PFGE pulsotype A, ST239-SCCmecIII-t030) was determined by using various molecular techniques. Infection control measures were started in ICU unit. Patients who had already been discharged to other services were put on contact isolation. No further cases occurred after 26th January and the outbreak declared over.

Keywords : MLST, MRSA, Outbreak
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