Control at hospital level of infections by methicillin-resistant staphylococci in children.

Rapid spread of methicillin-resistant staphylococci (MeRS) in a children's hospital is described. Within 4 months of the first isolation MeRS had been isolated from infections in all clinical units. MeRS were also regularly isolated at the out-patient department. Protective isolation of one of the clinical units had no effect on the infection rate by MeRS. The use of antiseptics (Hexachlorophene and chlorhexidine) and gentamicin nose cream in children and staff members in three out of five clinical units resulted in a significant reduction of the prevalence of nose colonization by MeRS in children. In staff members a non-significant reduction of the prevalence of colonization and a significant reduction of the acquisition of MeRS was found. After a few months the infection rate decreased to zero in the units where the measures were introduced. It remained unchanged in the other units. Phage typing of two sets of strains collected at an interval of 6 months showed that the infections were mainly caused by two endemic strains of MeRS. The majority of the infections caused by MeRS was of minor importance. In 16% of the infections a strain was isolated repeatedly and for more than 1 week. After the introduction of antiseptics a relative increase of infections by Gram-negative bacteria was observed. The significance of this phenomenon is discussed.