An Outbreak of Mupirocin-ResistantStaphylococcus aureuson a Dermatology Ward Associated with an Environmental Reservoir

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Abstract
Objective: To investigate a cluster of mupirocin-resistantStaphylococcus aureuson a dermatology ward.Design: An outbreak of mupirocin-resistantSaureus was noted on the dermatology ward during a prospective epidemiologic study of methicillin-resistantS aureus(MRSA) and borderline methicillin-susceptibleS aureus(BMSSA). Pulsed-field gel electrophoresis (PFGE) of whole-cell DNA digested with Sma I was used as a marker of strain identity.Setting and Patients: An 850-bed university hospital with a 12-bed inpatient dermatology ward. Most patients have severe, exfoliating dermatologic disorders.Results: MRSA or BMSSA were isolated from 13 patients on the dermatology ward over a 14-month period. Eleven of these isolates (84.6%) were mupirocin-resistant. Nine isolates were present on admission (81.8%); 8 of these patients had been hospitalized on the same ward within the last two months. Nasal and hand cultures from 36 personnel were negative for mupirocin-resistant MRSA or BMSSA. Extensive environmental culturing revealed that a blood pressure cuff and the patients' communal shower were positive for mupirocin-resistant BMSSA. PFGE of all mupirocin-resistant isolates demonstrated that the nine patients and both environmental sources had identical DNA typing patterns.Interventions: Changing of blood pressure cuffs between patients and more stringent cleaning of communal areas was initiated. Repeat environmental cultures were negative.Conclusions: S aureusis not usually associated with an environmental reservoir; however, these patients all had severe desquamation, which may have prolonged environmental contamination.