LRSA Outbreak II: The sequel

Another linezolid-resistant Staphylococcus aureus (LRSA) outbreak is described in this week’s JAMA. Eli posted a few months ago about the other outbreak, also in Spain, reported in Clinical Infectious Diseases (CID). The similarities between the two outbreaks are stunning, so please just check out Eli’s post for the most important take-home points about cfr-mediated linezolid resistance in staphylococci.

Hey, wait a minute....I think I know why these outbreaks seem so similar. The two papers report on the same outbreak. You wouldn’t know that right off the bat, because neither paper references the other. {see addendum below}

While I applaud the authors for adhering to the least publishable unit (LPU) concept that I hold so dear, I must reluctantly conclude that this is inappropriate. It was an ICU outbreak that involved 12 infections, and the authors should have been able to describe it in one paper. Before I detected the dual publication, I kept looking through the results and figures in the JAMA paper for more detail on some of the microbiology. The reason I didn’t find it was because it was all in the CID paper….

What additional information can we glean from the JAMA paper? In no particular order, we learn that this hospital had an aggressive MRSA active surveillance and decolonization program (but it’s still rife with MRSA and suffered the first big ICU outbreak of LRSA, which definitely proves something about active surveillance, I’m just not sure what); we learn that they did a whole bunch of environmental and hand cultures, only one of which was positive for LRSA (a single environmental culture, but wait, that was also reported in CID); we learn that they recognized the outbreak, did a bunch of stuff we always do when outbreaks occur, the outbreak went away, and no one is quite sure what all happened. Standard issue hospital infection prevention, in other words.

ADDENDUM: On first read I missed the fact that the authors actually did reference the earlier CID report in the JAMA paper--my apologies. I stand by my comment that the outbreak could and should have been reported in full in one manuscript, but at least the careful reader (which clearly doesn't describe me!) should be able to find his/her way to the additional details (mostly micro related) in the CID piece.

Eli's post
JAMA paper
CID paper


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