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BACKGROUND : Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) represent an increasing problem worldwide. INTERPRETATION : Physicians need to know that recommended guidelines regarding MRSA screening do not cover all types of risk situations. MRSA carriage among healthcare workers is probably not an important source of MRSA spread in hospitals. Measures to prevent cross infection between patients should be emphasised. RESULTS : During the fall of 1998, four patients in the dermatological ward and three of their relatives were infected or colonised with MRSA. The strain was probably introduced by an eczematous patient who had recently arrived from Japan. Three patients became chronic carriers. The second outbreak involved three other hospital departments in July-August 1999. The index patient, a multitraumatised japanese tourist, died 16 days after admission. Two other patients were infected, one of them became a chronic carrier. According to official guidelines, neither of the index patients needed MRSA screening. Pulsed field gel-electrophoresis of the MRSA isolates revealed two different strains at the first outbreak, both probably introduced from the index patient, and one single strain at the second outbreak. Nasal swabs of staff were negative. MATERIAL AND METHODS : We report two outbreaks of methicillin-resistant S. aureus at Haukeland University Hospital during 1998-99.

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