You are not currently logged in.
Access your personal account or get JSTOR access through your library or other institution:
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
Rosalind J. Carter , PhD, Genevieve Sorenson , RN, Richard Heffernan , MPH, Julia A. Kiehlbauch , PhD, John S. Kornblum , PhD, Robert J. Leggiadro , MD, Lucia J. Nixon , MD, William A. Wertheim , MD, Cynthia G. Whitney , MD, Marcelle Layton , MD and MDRSP Working Group
Infection Control and Hospital Epidemiology
Vol. 26, No. 3 (March 2005), pp. 248-255
Published by: Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Stable URL: http://www.jstor.org/stable/10.1086/502534
Page Count: 8
Preview not available
OBJECTIVES. 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. DESIGN. Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance. SETTING. An 80‐bed AIDS‐care unit in an LTCF. PARTICIPANTS. Staff and residents on the unit. RESULTS. 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. CONCLUSIONS. 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.
© 2005 by The Society for Healthcare Epidemiology of America. All rights reserved.