The problems, diagnosis and treatment of infection by Staphylococcus aureus

Changes in infection control practice to reduce MRSA infection

An increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) led to a review of infection control practice within the cardiothoracic directorate in a South London teaching hospital. Several changes in aspects of care were implemented including educational initiative, extension of the admission screening policy, a specific isolation nursing team and the development of a care pathway. This led to a considerable reduction in cross-infection rates. It was recognized that high-quality, high nurse-to-patient ratio and education on fundamental aspects of barrier nursing were necessary to maintain the low infection rates.

Staphylococcal septicaemia complicated by probable cloxacillin neurotoxicity and by jaundice induced by fusidic acid

Two weeks following a renal arteriogram a 56-year-old man with severe hypertension developed a staphylococcal septicaemia. After six weeks treatment with intravenous fusidic acid and cloxacillin he became icteric, confused and disorientated. The fusidic acid was stopped and the serum bilirubin fell to normal. His confusion persisted and serum cloxacillin levels were found to be grossly elevated. The patient's mental state returned to normal following withdrawal of cloxacillin. We attribute his jaundice to treatment with fusidic acid and his acute confusional state to cloxacillin neurotoxicity.