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Antimicrobial Resistance and Infection Control

, 1:37

First Online: 20 November 2012Received: 16 April 2012Accepted: 11 November 2012


BackgroundWe describe an outbreak of Bullous Impetigo BI, caused by a methicillin susceptible, fusidic acid resistant Staphylococcus aureus SA strain, spa- type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011.

MethodsWe performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates.

ResultsNineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers HCW with SA t408 was detected. These strains were MecA, PVL, Exfoliative Toxin ETA, ETB, ETAD, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak.

ConclusionsWe conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.

KeywordsMSSA EEFIC Raman Bullous impetigo Neonate AbbreviationsBIBullous Impetigo

EEFICEpidemic European Fusidic Acid-resistant Impetigo Clone

ETExfoliative toxin

GPGeneral practitioner

HCWHealthcare worker

MRSAMethicillin resistant staphylococcus aureus

MSSAMethicillin susceptible staphylococcus aureus

SAStaphylococcus aureus

SSSSStaphylococcal scalded skin syndrome.

Electronic supplementary materialThe online version of this article doi:10.1186-2047-2994-1-37 contains supplementary material, which is available to authorized users.

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Autor: Maike Koningstein - Leon Groen - Kathelijn Geraats-Peters - Suzanne Lutgens - Ariene Rietveld - Petr Jira - Jan Kluytmans -


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