How a hospital contained a community-based MRSA outbreak

Writing in USA Today this week, Peter Eisler explains how one hospital realized that its town was in the midst of a community-based outbreak of methicillin-resistant Staphylococcus aureus (MRSA)—and how they worked to contain the deadly bacteria.

An outbreak in Kentucky

Over the course of a few days, Saint Joseph-London Hospital in London, Ky., admitted three patients who tested positive for MRSA, but none had been in contact with hospitals, physicians, or each other. Two of the patients quickly died, while the third survived after spending three weeks in a coma.

"What really bothered me was the rapidity of their deterioration, a matter of hours," says Muhammad Iqbal, a pulmonologist who chairs the hospital's infection control committee, adding that the physicians "were worried that something was spreading across the community."

NEJM: How hospitals can win the fight against MRSA

The hospital ordered that any new patient with respiratory symptoms be isolated and tested for MRSA. They notified the state Health Department, which alerted other hospitals in the region to watch for symptoms and report cases; a few cases of now-deceased patients were identified with the same strain of MRSA, but all the cases were isolated.

There is still no known link between the victims, except that all reported catching a case of late-season flu. Epidemiologists posited that perhaps the MRSA was there all along and that the flu simply weakened the patients' immune systems enough for it to take over.

Expert: Communities are unprepared

MRSA was once confined mostly to hospitals, but community-based MRSA now causes more than 50% of all skin and soft tissue infections that end in hospitalization. Some community-borne strains carry a toxin linked to a lung-ravaging "necrotizing" pneumonia that may strike with the flu or another underlying illness. Overall, data suggest that MRSA infections outside the hospitals are responsible for upwards of 20,000 deaths per year.

According to a USA Today investigation, most community-based MRSA cases go uncounted because CDC can only track those that escalate to life-threatening infections.

Moreover, communities are unprepared for most outbreaks, often lacking a structure to prevent or reduce MRSA from spreading. CDC has issued guidelines encouraging strong personal hygiene and discouraging sharing personal items, but there is no way to know if the measures are adopted (Eisler, USA Today, 12/16).