ABSTRACT
OBJECTIVE: To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner. SETTING: A medical practitioner's office and 4 hospitals in Perth, Western Australia. PATIENTS: Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner. METHODS: We performed a prospective and retrospective outbreak investigation, including MRSA colonization surveillance, environmental sampling for MRSA, and detailed molecular typing of MRSA isolates. We performed an infection control audit of the medical practitioner's premises and practices and administered MRSA decolonization therapy to the medical practitioner. RESULTS: Eight cases of invasive MRSA infection were identified. Seven cases occurred as a cluster in May 2004; another case (identified retrospectively) occurred approximately 15 months earlier in February 2003. The primary sites of infection were the neck, shoulder, lower back, and hip: 5 patients had septic arthritis and bursitis, and 3 had pyomyositis; 3 patients had bacteremia, including 1 patient with possible endocarditis. The medical practitioner was found to be colonized with the same MRSA clone [ST22-MRSA-IV (EMRSA-15)] at 2 time points: shortly after the first case of infection in March 2003 and again in May 2004. After the medical practitioner's premises and practices were audited and he himself received MRSA decolonization therapy, no further cases were identified. CONCLUSIONS: This outbreak most likely resulted from a breakdown in sterile technique during percutaneous needle procedures, resulting in the transmission of MRSA from the medical practitioner to the patients. This report demonstrates the importance of surveillance and molecular typing in the identification and control of outbreaks of MRSA infection.
Subject(s)
Acupuncture Therapy/adverse effects , Disease Outbreaks , Infectious Disease Transmission, Professional-to-Patient , Injections/adverse effects , Methicillin Resistance , Staphylococcal Infections , Staphylococcus aureus/drug effects , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/therapy , Female , Health Personnel , Humans , Infection Control/methods , Male , Middle Aged , Pyomyositis/therapy , Shoulder Joint/drug effects , Shoulder Joint/microbiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcal Infections/transmission , Staphylococcus aureus/classification , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purification , Western Australia/epidemiologySubject(s)
Discitis/microbiology , Osteomyelitis/microbiology , Spinal Diseases/microbiology , Streptococcal Infections , Discitis/diagnosis , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Humans , Male , Middle Aged , Osteomyelitis/diagnosis , Streptococcal Infections/diagnosisABSTRACT
A case of euryblepharon with lateral ectropion is reported, with photographs from infancy to adult life. The value of obtaining photographs, if available, in cases such as this is stressed, to avoid unnecessary clinical studies being done. The photographs indicate the stability of the condition. They also indicate that, at least in some cases, the ectropion will become less apparent with body growth and may need no therapy.
