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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: ramgeorge@hotmail.com
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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

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