ANALYSIS OF NOSOCOMIAL OUTBREAKS WITH MULTIPLY AND METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS (MRSA) IN GERMANY - IMPLICATIONS FOR HOSPITAL HYGIENE

Two outbreaks of nosocomial infections with MRSA, one in a urological unit in connection with transurethral prostatectomy and the other in a n orthopaedic clinic with infections after implantation of prosthetic hips, have been analyzed on the basis of typing MRSA by phage-patterns , plasmid profiles and genomic DNA fragment patterns, Main reasons for these outbreaks were obviously mistakes in hospital hygiene and an in appropriate antibiotic prophylaxis (in the first outbreak a quinolone over about 7 days, in the second a third generation cephalosporin). Bo th outbreaks could be stopped by measures of hospital hygiene includin g isolated or cohort nursing of affected patients, and change in antib iotic prophylaxis. Intensive care units (ICUs) are more often affected by MRSA than other clinical settings. As described by the example of an outbreak with MRSA in a municipal hospital, ICUs can play a special role in intrahospital spread of MRSA. The recently observed inter-reg ional clonal interhospital dissemination of MRSA in Germany is mainly due to a transfer of patients between hospitals; prewarning of the hos pital of destination and a number of hygiene measures can prevent furt her spread.