Hospital-related outbreak of infection with multidrug-resistant Streptococcus pneumoniae in the Netherlands

Multidrug-resistant strains of Streptococcus pneumoniae were isolated over a two-year period (July 1995 until August 1997) from the sputum of 36 patie nts who were hospitalized in a Dutch medical centre. Nosocomial transmissio n was confirmed by typing of the bacterial isolates: all 36 multidrug-resis tant isolates shared the same genotype, serotype, and displayed overlapping drug resistance profiles. Thirty-two of the 36 (89%) patients had chronic obstructive pulmonary disease (COPD). The outbreak was initiated by a 76-ye ar old patient, who had been colonized with the same strain since 1993. Bec ause staff screening of the hospital and pulmonary function department was negative, patient-to-patient spread was the most likely cause of this outbr eak. The epidemic ceased following the commencement of barrier nursing, a t reatment course of ceftriaxone, and a five-day rifampicin eradication thera py for the positive patients. The outbreak resulted from failure to recogni ze quickly the rapid transmission of this multidrug-resistant pneumococcal clone. We conclude that patients with COPD are at high risk of acquiring mu ltidrug resistant pneumococci, and suggest that COPD patients who are colon ized or infected with multidrug-resistant pneumococci should be isolated to prevent future transmission.