A PROLONGED OUTBREAK OF EXFOLIATIVE TOXIN A-PRODUCING STAPHYLOCOCCUS-AUREUS IN A NEWBORN NURSERY

An outbreak of erythromycin-resistant, exfoliative toxin-producing Sta phylococcus aureus infection in a neonatal unit is described. The orga nism was coagulase positive but staphyloslide negative, and this unusu al phenotype facilitated early recognition of the organism in the rout ine laboratory. In the initial outbreak there were 77 probable or conf irmed eases, with a peak attack rate of 66%. Increased infection contr ol measures were put in place and attempts were made to identify a sta ff carrier. No carriers were found and the major outbreak subsided. Sp oradic cases occurred over the following 10 months, until May 1992, wh en a colonized staffperson was discovered. She was treated and no furt her cases occurred. The causative organism was subjected to typing by phage, enterobacterial repetitive intergenic consensus sequence polyme rase chain reaction, and pulsed-field gel electrophoresis with two sep arate enzymes. The phage typing and genomic tests confirmed the presen ce of the same clone in the unit for 9 months. The organism possessed genes encoding exfoliative toxin A as determined by polymerase chain r eaction.