OUTBREAK AMONG HIV-INFECTED PATIENTS OF STAPHYLOCOCCUS-AUREUS RESISTANT TO COTRIMOXAZOLE AND METHICILLIN

OBJECTIVE: To describe an outbreak of trimethoprim-sulfamethoxazole (c otrimoxazole)-resistant and methicillin-resistant Staphylococcus aureu s (CMRSA) in a unit housing patients infected with the human immunodef iciency virus (HIV). DESIGN: Prospective study involving patients colo nized or infected with CMRSA.PATIENTS: 15 hospitalized patients with c ultures positive for CMRSA. METHODS: Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carrie d out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA. RESULTS: The epidemic was brought under control with the reinforcement of nosocomial transmissi on measures and with systematic nasal decontamination with mupirocin o f all patients admitted to the HIV unit. Molecular typing techniques s howed the existence of two epidemic strains: strain A was present in t he 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere. CONCLUSIONS: Cotrimoxazole may no l onger be a reliable and effective alternative for glycopeptides in pat ients with infection caused by MRSA strains, and HIV units should be p articularly alert for CMRSA strains.