Failure To Control an Outbreak of Multidrug‐Resistant Streptococcus pneumoniae in a Long‐Term‐Care Facility: Emergence and Ongoing Transmission of a Fluoroquinolone‐Resistant Strain

To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term-care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP...

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Published in:	Infection control and hospital epidemiology Vol. 26; no. 3; pp. 248 - 255
Main Authors:	Carter, Rosalind J., Sorenson, Genevieve, Heffernan, Richard, Kiehlbauch, Julia A., Kornblum, John S., Leggiadro, Robert J., Nixon, Lucia J., Wertheim, William A., Whitney, Cynthia G., Layton, Marcelle
Format:	Journal Article
Language:	English
Published:	Thorofare, NJ The University of Chicago Press 01-03-2005 Slack Cambridge University Press
Subjects:	Acquired Immunodeficiency Syndrome - complications Acquired Immunodeficiency Syndrome - microbiology Adult Antibacterial agents Antibiotic Prophylaxis Antibiotics. Antiinfectious agents. Antiparasitic agents Antimicrobials Bacterial diseases Bacterial Vaccines - immunology Biological and medical sciences Blood Colonization Cross Infection - microbiology Cross Infection - prevention & control Cross Infection - transmission Disease outbreaks Disease Outbreaks - prevention & control Disease risk DNA, Bacterial - analysis DNA, Bacterial - genetics Drug Resistance, Bacterial - drug effects Drug Resistance, Bacterial - immunology Drug Resistance, Multiple - drug effects Drug Resistance, Multiple - immunology Electrophoresis, Gel, Pulsed-Field Epidemiology Female Health Facilities Human bacterial diseases Humans Infectious diseases Length of Stay Long-Term Care Male Medical sciences Microbial colonization Middle Aged Nasopharyngeal Diseases - epidemiology Nasopharyngeal Diseases - microbiology Nasopharyngeal Diseases - prevention & control New York - epidemiology Nursing Original Articles Outbreaks Pharmacology. Drug treatments Pneumococcal Infections - complications Pneumococcal Infections - epidemiology Pneumococcal Infections - microbiology Preventive medicine Prophylaxis Risk Factors Sputum Staphylococcal infections, streptococcal infections, pneumococcal infections Streptococcus pneumoniae Streptococcus pneumoniae - genetics Streptococcus pneumoniae - immunology Streptococcus pneumoniae - isolation & purification Vaccination New York Epidemic Transmission Check Epidemiology Streptococcus pneumoniae Infection Prevention Streptococcaceae Fluoroquinolone derivatives Streptococcal infection Multiple resistance Streptococcus A Bacteriosis Bacteria Micrococcales Antibacterial agent Homes for the aged Pneumococcal infection Failure
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Summary:	To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term-care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain. Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance. An 80-bed AIDS-care unit in an LTCF PARTICIPANTS: Staff and residents on the unit. From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n=65) and staff (n=70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized. Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0899-823X 1559-6834
DOI:	10.1086/502534