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Outbreak of Invasive Methicillin-Resistant Staphylococcus aureus Infection Associated With Acupuncture and Joint Injection

Published online by Cambridge University Press:  02 January 2015

R. J. Murray ,
J. C. Pearson ,
G. W. Coombs ,
J. P. Flexman ,
C. L. Golledge ,
D. J. Speers ,
J. R. Dyer ,
D. G. McLellan ,
M. Reilly  and
J. M. Bell
...Show all authors
R. J. Murray*
Affiliation:
Department of Microbiology and Infectious Diseases, Path West Laboratory Medicine WA–Royal Perth Hospital, Australia
J. C. Pearson
Affiliation:
Department of Microbiology and Infectious Diseases, Path West Laboratory Medicine WA–Royal Perth Hospital, Australia
G. W. Coombs
Affiliation:
Department of Microbiology and Infectious Diseases, Path West Laboratory Medicine WA–Royal Perth Hospital, Australia
J. P. Flexman
Affiliation:
Department of Microbiology and Infectious Diseases, Path West Laboratory Medicine WA–Royal Perth Hospital, Australia
C. L. Golledge
Affiliation:
Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Queen Elizabeth II Medical Centre, Australia
D. J. Speers
Affiliation:
Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA-Queen Elizabeth II Medical Centre, Australia
J. R. Dyer
Affiliation:
Infectious Diseases Department, Australia
D. G. McLellan
Affiliation:
Infectious Diseases Department, Australia Western Diagnostic Pathology, Australia
M. Reilly
Affiliation:
Hands-On Infection Control, Australia
J. M. Bell
Affiliation:
West Perth, Perth, Western Australia, and the Department of Microbiology and Infectious Diseases, Women's and Children's Hospital, Adelaide, South Australia, Australia
S. F. Bowen
Affiliation:
Communicable Diseases Control Directorate, Western Australian Department of Health, Australia Clinical Services, Fremantle Hospital and Health Services, Perth, Western Australia, Australia
K. J. Christiansen
Affiliation:
Department of Microbiology and Infectious Diseases, Path West Laboratory Medicine WA–Royal Perth Hospital, Australia
*
Department of Microbiology and Infectious Diseases, Path West Laboratory Medicine Western Australia, Royal Perth Hospital, GPO Box X2213 Perth, Western Australia 6847, Australia (ronan.murray@health.wa.gov.au)
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Abstract

Objective.

To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner.

Setting.

A medical practitioner's office and 4 hospitals in Perth, Western Australia.

Patients.

Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner.

Methods.

We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner.

Results.

Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified.

Conclusions.

This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 859 - 865
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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