West Virginia
Infectious Disease Epidemiology Program

West Virginia Department of Health and Human Resources Information for Physicians - Staphylococcus aureus Infection

Do I need to be concerned about resistant Staphylococcus aureus infection in West Virginia?

Beginning in January 2003, an outbreak of methicillin resistant Staphylococcus aureus (MRSA) skin infections has been identified in several correctional facilities and regional jails in our state.

A variety of other information suggest the problem is worsening nationwide:

• Community-acquired MRSA infections in children without risk factors was reported from a series of hospitalized patients in Chicago in 1998 (1), and fatal MRSA infection was reported in four previously healthy children in 1999 (2).

• Outbreaks of skin infections due to community-acquired MRSA have recently been identified in prisons, men who have sex with men, and athletic teams (3-5).

• In addition, the first cases of Vancomycin resistant Staphylococcus aureus have now been reported in the US (6,7).

Local care, including incision and drainage, is the mainstay of treatment for skin infections. Providers should have a low threshold for obtaining cultures of infected skin lesions, especially if antibiotics are prescribed. Antibiotic choice should be adjusted according to susceptibilities of the identified pathogen.

Excellent guidelines for management of skin infections and MRSA in correctional institutions are available at: http://nicic.org/Downloads/PDF/2003/MRSA703.pdf

In outpatient practice, respiratory illness is the most common reason for prescribing antibiotics. Avoid unnecessary antibiotic use by following current guidelines for management of common pediatric (8-13) and adult (14-18) upper respiratory infections. Pediatric provider and parent education materials are available at:

http://www.wvdhhr.org/bph/oehp/sdc/a-z/a-z-antibiotic_resistance.htm

Infection control guidelines for hospitals and nursing homes have recently been updated (19) to recommend:

• Active surveillance cultures for all patients at high risk for carriage of MRSA or vancomycin resistant enterococcus.

• Contact isolation for all colonized or infected patients. Isolation should include private room for the patient; and gloves, gowns and masks for health care workers. If a private room is not available, the patient can share a room with another patient who is colonized with the same pathogen.

• Rigorous hand hygiene.

In psychiatric wards or nursing homes, contact precautions may require modification allowing social contact while limiting physical contact.

A 12-step program for control of antimicrobial resistance in hospitals and dialysis centers has been designed by CDC and is available at: http://www.cdc.gov/drugresistance/healthcare/patients.htm

Report any of the following to your local health department or the West Virginia Bureau for Public Health (800-423-1271):

• Community-acquired MRSA (includes cases from corrections or regional jails);

• Vancomycin intermediate or resistant Staphylococcus aureus; and

• Outbreaks.

A patient education sheet on MRSA is available at: http://www.wvdhhr.org/bph/oehp/sdc/PDFs/IDEP/mrsa_faq_public.pdf

JAMA, 1998; 279:593.

MMWR, 1999; 48:707.

MMWR, 2001; 50:919.

MMWR, 2003; 52:88.

MMWR, 2003; 52:793.

MMWR, 2002; 51:565.

MMWR, 2002; 51:902.

Pediatrics, 1998; 101:163.

Pediatrics, 1998; 101:165.

Pediatrics, 1998; 101:171.

Pediatrics, 1998; 101:174.

Pediatrics, 1998; 101:178.

Pediatrics, 1998; 101:181

Ann Intern Med, 2001; 134:479.

Ann Intern Med, 2001; 134:490.

Ann Intern Med, 2001; 134:498.

Ann Intern Med, 2001; 134:509.

Ann Intern Med, 2001; 134:521.

Infect Control Hosp Epidemiolol, 2003; 24:362.

State of West Virginia (WV)
West Virginia Department of Health and Human Resources (DHHR)
Bureau for Public Health (BPH)
Office of Epidemiology and Health Promotion (OEHP)
Division of Surveillance and Disease Control (DSDC)
Infectious Disease Epidemiology Program (IDEP)

A-Z Listing of West Virginia's Reportable Diseases

This FAQ was last updated September 2003.
If you have questions or comments about the West Virginia Division of Surveillance and Disease Control, please direct them to Loretta Haddy at Loretta.E.Haddy@wv.gov.
If you have questions or comments about this Web page, please direct them to Betty Jo Tyler at Betty.J.Tyler@wv.gov.