This was reported in the latest issue of Emerging Infectious Diseases, a journal produced by the Centers for Disease Control and Prevention.
Infection with MRSA has been reported in the United States for over 30 years.
Initially, MRSA infections were primarily a problem of hospitals and nursing homes; by 1997, 50% of healthcare-acquired S. aureus isolates in the United States were methicillin resistant.
Beginning in the early 1980s, cases of community-acquired MRSA were reported, primarily in people with a history of injection drug use and other high-risk patients.
More recently, community-acquired MRSA has been described in both adults and children who have not had extensive exposure to hospitals or other apparent risk factors.
In this unique report, a food handler, food specimen, and 3 ill patrons were all found to be culture-positive for the same toxin-producing strain of MRSA.
A family purchased shredded barbecued pork and coleslaw, and 3-4 hours after eating the meal, 3 adults had nausea, vomiting, and stomach cramps.
Market employees were interviewed, and stool cultures were obtained from the three ill family members.
| MRSA is becoming increasingly common in the community.
| Emerging Infectious Diseases |
Specimens of barbecued pork and coleslaw were collected from the market, and nasopharyngeal swabs were collected for culture from three food preparers.
Twelve cultures of S. aureus, recovered from stool samples of the ill family members, food specimens, and nasal swabs of the food preparers, were sent to the Centers for Disease Control and Prevention for further testing.
Comparison of all the isolates, by pulsed-field gel electrophoresis, showed that 5 of the isolates were indistinguishable. These isolates were those from the stool cultures of three family members, the coleslaw; and from the nasal swab of a food preparer.
The food handler, who was carrying the outbreak strain of MRSA, performed various tasks at the store, including preparing foods and handling barbecued pork and coleslaw.
She reported no recent gastrointestinal illness or chronic health problems, history of admission to a hospital, or use of antibiotics in the previous 6 months. She also denied close contact with people who lived or worked in healthcare facilities or other group settings.
She did, however, visit an elderly relative, who resided in a nursing home, approximately 2 to 3 times each month before the outbreak. She reported that this relative had a staphylococcal infection and had subsequently died.
Timothy F. Jones, of the Tennessee Department of Health, Nashville, Tennessee, said on behalf of fellow authors, "This outbreak suggests that as MRSA becomes increasingly common in the community, it will be implicated in expressions of all the clinical manifestations of staphylococcal infection."
"While antibiotic-resistant strains are not expected to be clinically more virulent or challenging in the setting of acute outbreaks of gastroenteritis, MRSA may cause soft-tissue and other infections in the community that are difficult to treat," it was concluded.