MRSA in a hospital social worker

LETTERS TO THE EDITOR

MRSA IN A HOSPITAL SOCIAL WORKER To the Editor: Infection with methicillin-resistant Staphylococcus aureus (MRSA) in nurses working with patients who are colonized or infected with MRSA has been reported in several studies [ 1.21.However, we are unaware of any reports of a hospital employee who had little or no “laying-on-of-hands” contact with MRSA-positive patients in whom an infection developed. This report describes a case in a hospital social worker. The patient is a 38 year old healthy female with no recent history of antibiotic usage. Swelling and tenderness developed around the nailbed of the right fourth toe, which had been irritated while jogging approximately two weeks previously. Within three days, weigh-bearing became painful, and she sought medical treatm&nt. Her physician ibcised and drained the lesion, sent a sample of of the drainage material for culture and prescribed VeloseP and warm soaks. She was instructed to remain at home until the lesion healed. Cultures of the drainage yielded numerous Staph. aureus organisms with the following antibiotic sensitivity patterns: Minimum Inhibitory Concentrations Clindamycin Penicillin G Nafcillin Cephalothin Tetracycline Cotrimoxazole Erythromycin Vancomycin

&g/ml)

Kirby-Bauer Disc Sensitivities

10.25 64 16 2 10.25
Sensitive Resistant Resistant Sensitive Sensitive Sensitive Resistant Sensitive

This organism is one of several strains endemic in our hospital. Nasopharyngeal, axillary and toe web cultures were performed to determine sites of colonization. Only the nasopharyngeal culture was positive. Previous reports [l-3] indicate colonization or illness with

MRSA among medical personnel usually occurs when employees work extensively with infected or colonized patients. This employee had minimal contact with patients known to be MRSA-positive. We hypothesize that the source of this patient’s infection was probably her previously colonized nasopharynx. Nasal colonization has been observed in only a small percentage (0.6 to 6 percent) of personnel closely associated with MRSA-positive patients with MRSA outbreaks [1,4]. Factors responsible for this infrequent occurrence are not understood, but nasopharyngeal colonization has been suggested as a possible mode of transmission of MRSA within a hospital [4]. It appears that healthypersonscan become colonized and infected. More studies are necessary to investigate the significance of nasopharyngeal colonization in an employee without extensive patient contact (“unsuspectad can-ier”) in relationship to the spread of MRSA within the hospital and the possibility of introduction of MRSA into the community. JACQUELINEOCTAVIO,R.N. Infection Control Practitioner JOHNE. CONTE,JR., M.D. Chairman, Hospital Infection Control Committee University of California San Francisco, California 94143 References Klitnek JJ, h4wsikFJ,BartlettRC,Weir 8, Shea P, Qulntiliini R: Clinical, epidemiofo9lc and bacteriologic observations of an outbreak of methkillin-res&tartt Staphylococcus aureusat a large community hospital. Am J Med 1976; 61: 340-345. Crossley K, LandeemanB, Zaske D: An outbreak of infections caused by strains of Staphyo~~~~~ amus resistant to methicillin and arninoglycuskjes. II. Epidemiologic studies. J Infect Dis 1979; 139: 280-207. Peacock JE Jr, Marsik FJ. Wenrel RP: Methicillin-resistant Staphylococcus aureus:intrcduct&n and spread within a hospital. Ann intern h4ed 1980; 93: 526-532. Brvca JM. Len&v M. Deetz TR. DuPont HL: Eddemio)aaic studies of en rGso&nialm&kMn-resl&t !hphylGoccus aureus -&of infections. Infection Control t981; 2: 110-116.

A61