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Elucidation by Plasmid Analysis

Emily Rhinehart, RN; David M. Shlaes, MD, PhD; Thomas F. Keys, MD; Janet Serkey, RN; Barbara Kirkley, MT; Chee Kim; Charlotte A. Currie-McCumber, MS; Geraldine Hall, PhD

Arch Intern Med. 1987;147(3):521-524.

Abstract
• An outbreak of methicillin sodium-resistant Staphylococcus aureus (MRSA) infection and colonization, mainly centered in the vascular surgery service, occurred in a 1000-bed tertiary care center between December 1983 and December 1984. Methicillin-resistant S aureus isolated before and during the outbreak was studied by both bacteriophage typing and by restriction endonuclease digestion of bacterial plasmid DNA. Bacteriophage typing was discrepant in nine (56%) of the 17 repeated analyses compared with one (3.4%) of the 29 for plasmid profiling. These typing methods revealed that the epidemic strain was introduced to the hospital from the community 15 months before the outbreak. The outbreak was caused by cross-transmission of the epidemic strain by health care personnel and was controlled by treatment of colonized personnel, education of personnel, and institution of barrier precautions for colonized or infected patients. Plasmid profiling with restriction endonuclease digestion was easier, more rapid, and more specific than bacteriophage typing in the evaluation of this outbreak.

(Arch Intern Med 1987;147:521-524)

Author Affiliations
From the Cleveland Clinic Foundation (Mss Rhinehart, Serkey, and Kirkley and Drs Keys and Hall), the Cleveland Veterans Administration Medical Center (Dr Shlaes and Mss Kim and Currie-McCumber), and Case Western Reserve University School of Medicine (Dr Shlaes).

Footnotes
Accepted for publication July 1, 1986.

Read in part before the annual meeting of the American Society for Microbiology, Las Vegas, March 5 and 7, 1985.

Reprint requests to Department of Infectious Disease, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44106 (Dr Keys).

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