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AbstractObjective:To investigate a cluster of mupirocin-resistant Staphylococcus aureuson a dermatology ward.Design:An outbreak of mupirocin-resistant Saureus was noted on the dermatology ward during a prospective epidemiologic study of methicillin-resistant S aureus(MRSA) and borderline methicillin-susceptible S aureus(BMSSA). Pulsed-field gel electrophoresis (PFGE) of whole-cell DNA digested with Sma I was used as a marker of strain identity.Setting and Patients:An 850-bed university hospital with a 12-bed inpatient dermatology ward. Most patients have severe, exfoliating dermatologic disorders.Results:MRSA or BMSSA were isolated from 13 patients on the dermatology ward over a 14-month period. Eleven of these isolates (84.6%) were mupirocin-resistant. Nine isolates were present on admission (81.8%); 8 of these patients had been hospitalized on the same ward within the last two months. Nasal and hand cultures from 36 personnel were negative for mupirocin-resistant MRSA or BMSSA. Extensive environmental culturing revealed that a blood pressure cuff and the patients' communal shower were positive for mupirocin-resistant BMSSA. PFGE of all mupirocin-resistant isolates demonstrated that the nine patients and both environmental sources had identical DNA typing patterns.Interventions:Changing of blood pressure cuffs between patients and more stringent cleaning of communal areas was initiated. Repeat environmental cultures were negative.Conclusions:S aureusis not usually associated with an environmental reservoir; however, these patients all had severe desquamation, which may have prolonged environmental contamination.

AbstractObjective:To investigate a mixed Salmonella heidelbergand Campylobacter jejunifoodborne outbreak in a nursing home.Design:Retrospective cohort study with a nested case-control design. Cases were defined by positive stool-culture results. Controls needed to be both asymptomatic and culture-negative.Setting and Patients:Residents of a 580-bed nursing home in Brooklyn, New York.Results:Of the 580 residents, 119 (21%) developed illness. Of the 93 symptomatic patients who submitted specimens, cultures were positive for S heidelbergin 24 (26%), C jejuniin 14 (15%), and both microorganisms in 25 (27%).Only the pureed diet was associated highly with infection by either Salmonella(odds ratio [OR], 17.6; 95% confidence interval [CI95], 4.8-68.7; P<.001), Campylobacter(OR, 13.3; CI95, 3.2-59.2; P<.001), or both organisms (OR, 8.9; CI95, 2.7-30.3; P<.001). Among the 52 pureed foods served during the 5 days before the outbreak, five meat or poultry items were associated most strongly with culture positivity.Of these five meat items, only a chopped-liver salad was implicated by the two employees reporting illness. A reported food-handling error occurred when ground, cooked chicken livers were placed in a bowl containing raw chicken-liver juices.Intervention:Recommendations for proper cleaning and sanitizing of kitchen equipment to prevent cross-contamination between raw and cooked foods.Conclusions:Mixed foodborne outbreaks occur rarely. During this outbreak, contamination of a single food item with multiple bacterial pathogens was the likely source of transmission. Improper food-handling techniques that promote growth of one microorganism also allow growth of other pathogens that may be present. Because different sources and routes of transmission may be implicated for different pathogens, specific preventive measures may vary depending on the organisms involved.