Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Apr;35(4):412-8.
doi: 10.1086/675594.

Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention

Victor O Popoola  1 , Alicia Budd, Sara M Wittig, Tracy Ross, Susan W Aucott, Trish M Perl, Karen C Carroll, Aaron M Milstone
Affiliations

Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention

Victor O Popoola et al. Infect Control Hosp Epidemiol. 2014 Apr.

Abstract

Objective: To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control.

Setting and design: Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home.

Methods: Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and an MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE).

Results: Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for 21 days or more became recolonized with MRSA. Using PFGE, there were 14 different strain types identified, with USA300 being the most common (31%).

Conclusions: Current strategies to prevent infections-including active identification and decolonization of MRSA-colonized neonates-are inadequate because infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest: All other authors report no disclosures.

Figures

Figure 1
Figure 1
A flowchart detailing the identification of neonates with methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit with an active surveillance and decolonization program. aNeonate did not meet NHSN criteria for infection at time of first culture growing MRSA; b Neonate met NHSN criteria for infection at time of first culture growing MRSA.
Figure 2
Figure 2
Quarterly incidence of MRSA transmission and infection from 2007 to 2011 in a setting of active surveillance and decolonization. Straight lines represent the trend in compliance with hand hygiene (solid line; Prob>F=0.0001; R2=0.75) and an MRSA decolonization protocol (broken line; Prob>F=0.11; R2=0.14) as estimated by linear regression.
Figure 3
Figure 3
Distribution of MRSA strains isolated from patients. Each letter represents a unique strain.
See this image and copyright information in PMC

References

    1. Klevens RM, Edwards JR, Richards CL, Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160–166. - PMC - PubMed
    1. Stoll BJ, Hansen NI, Adams-Chapman I, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292(19):2357–2365. - PubMed
    1. Schlapbach LJ, Aebischer M, Adams M, et al. Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants. Pediatrics. 2011;128(2):e348–e357. - PubMed
    1. Hocevar SN, Edwards JR, Horan TC, Morrell GC, Iwamoto M, Lessa FC. Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol. 2012;33(12):1200–1206. - PMC - PubMed
    1. Lessa FC, Edwards JR, Fridkin SK, Tenover FC, Horan TC, Gorwitz RJ. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995-2004. Pediatr Infect Dis J. 2009;28(7):577–581. - PubMed

Publication types

MeSH terms