In September 2009, 4 patients on a single clinical unit in a nursing home were f

Question

In September 2009, 4 patients on a single clinical unit in a nursing home were found to have skin and softtissue infections due to methicillinresistant Staphylococcus aureus (MRSA). One of these patients had recently been transferred from hospital X. Two healthcare workers in the nursing home were found to be colonized with MRSA. Isolates from the patients and healthcare workers were genotyped by pulsedfield gel electrophoresis (PFGE) with the restriction enzyme SmaI (see Figure below). Lanes 58 are isolates from the 4 patients. Lane 2 is an isolate from healthcare worker A and lane 4 is an isolate from healthcare worker B. Lanes 3 and 9 are control strains and lanes 1 and 10 are molecular size ladders.


2. For both of these potential sources, what additional epidemiologic and/or molecular information would be needed to conclude that it is the likely source of the outbreak?

Explanation / Answer

For both of the sources additional epidemiologic and molecular information would be needed to conclude that is is the likely source of the outbreak. First if the MRSA patient was isolated, then the list of people who entered his room must be checked for MRSA. The bedding of the room can be checked. If the patient was not isolated, then all the people in that particular ward must be checked for MRSA. The bedding of the ward can be checked. If these two surveys prove that the outbreak was not due to the MRSA patient then the source of the outbreak must be from some other patient who has not yet been tested for MRSA but is positive for it.

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