An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-seropositive persons

Staphylococcus aureus is a cause of considerable morbidity and mortality in HIV-seropositive persons. Although methicillin-resistant S. aureus (MRSA) is encountered worldwide and in many areas of medical care, little has been reported on clinical infection with MRSA in patients with HIV. We report o n an outbreak of MRSA infection in HIV antibody positive patients, using ca se reports to describe an outbreak of MRSA infection in HIV-seropositive pe rsons. Six cases of clinical MRSA infection were reported over a 4-week period on patients on an HIV dedicated ward. All cases had previous AIDS diagnoses an d low CD4 cell counts (median 8x10(6)/l; range 0 to 238). Two cases had inf ected skin lesions and 2 cases had infected indwelling central venous cathe ters with septicaemia. Two cases had pneumonia, one with concurrent infecti on at the entry site of a percutaneous endoscopic gastrostomy (PEG) feeding tube. Isolates of MRSA from the 6 cases were compared by pulsed-field gel electrophoresis of Sma1 chromosomal digests. The resultant banding pattern showed the same strain was responsible for all the infections. A seventh in patient, the index case, had positive carriage with the same strain of MRSA . To define ongoing MRSA carriage after the outbreak, 29 consecutive ward pat ients were swabbed for MRSA: all were negative. All patients identified wit h MRSA infection responded to treatment with intravenous teicoplanin, altho ugh carriage was unaltered. Four of the 6 cases died within 7 weeks of diag nosis of MRSA. MRSA can cause severe morbidity in patients with end-stage HIV disease. A s mall outbreak of MRSA was controlled by simple precautionary measures with no subsequent ongoing transmission of MRSA.