Epidemiological analysis of methicillin-resistant Staphylococcus aureus in a Zagreb Trauma Hospital using a randomly amplified polymorphic DNA-typing method.

During a 1-month period in 1996, all inpatients and staff in the Zagreb Trauma Hospital were screened for methicillin-resistant Staphylococcus aureus (MRSA) carriage in order to control MRSA spread within the hospital. During the study period, 663 patients were admitted to the hospital, and screening prior to discharge revealed that 42 were colonised or infected with MRSA. Twenty-three (55%) of these would not have been detected if active screening had not been performed. Amongst 205 staff members, MRSA carriage was only found in one (0.5%) nurse. The prevalence and incidence of MRSA carriage varied significantly amongst the wards and was related to the length of hospital stay. One-third of the patients colonised or infected with MRSA had a history of previous admission to another hospital, and one-third were transferred to another institution after discharge. Thirty-nine of 42 MRSA isolates shared the same antibiotic sensitivity pattern, suggesting endemic spread of MRSA. However, randomly amplified polymorphic DNA molecular typing revealed four profiles, the most common involving 15 of 36 tested strains. There was no obvious clustering of epidemiological types by ward, except for the appearance of a single type on the burns unit, and it was likely that different strains had been introduced into the hospital by patient transfers from elsewhere. The results of this study indicate that a substantial proportion of MRSA carriers escape infection control measures if active screening is not performed. Based on the results of this study, steps have been taken to improve interhospital communication about the transfer of patients colonised with MRSA. Randomly amplified polymorphic DNA typing proved to be a useful aid to epidemiological investigations of MRSA.