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Clinical and Economic Impact of Methicillin-Resistant Staphylococcus aureus Colonization or Infection on Neonates in Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Xiaoyan Song ,
Eli Perencevich ,
Joseph Campos ,
Billie L. Short  and
Nalini Singh
Xiaoyan Song*
Affiliation:
Children's National Medical Center and, George Washington University Medical Center, Washington, DC
Eli Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, Maryland
Joseph Campos
Affiliation:
Children's National Medical Center and, George Washington University Medical Center, Washington, DC
Billie L. Short
Affiliation:
Children's National Medical Center and, George Washington University Medical Center, Washington, DC
Nalini Singh
Affiliation:
Children's National Medical Center and, George Washington University Medical Center, Washington, DC
*
Div of Infectious Disease, Children's National Medical Center, George Washington University Medical Center, Ste W3.5-100, ID, 111 Michigan Ave NW, Washington, DC 20010, (xsong@cnmc.org)
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Extract

Objective.

The rising incidence and mortality of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in children has become a great concern. This study aimed to determine the clinical and economic impact of MRSA colonization or infection on infants and to measure excess mortality, length of stay, and hospital charges attributable to MRSA.

Design.

This is a retrospective cohort study.

Setting and Patients.

The study included infants admitted to a level III-IV neonatal intensive care unit from September 1, 2004, through March 31, 2008.

Methods.

A time-dependent proportional hazard model was used to analyze the association between MRSA colonization or infection and mortality. The relationships between MRSA colonization or infection and length of stay and between MRSA colonization or infection and hospital charges were assessed using a matched cohort study design.

Results.

Of 2,280 infants, 191 (8.4%) had MRSA colonization or infection. Of 132 MRSA isolates with antibiotic susceptibility results, 106 were resistant to clindamycin and/or trimethoprim-sulfamethoxazole, thus representing a noncommunity phenotype. The mortality rate was 17.8% for patients with MRSA colonization or infection and 11.5% for control subjects. Neither MRSA colonization (hazard ratio [HR], 0.9 [95% confidence interval {CI}, 0.5-1.5]; P > .05) nor infection (HR, 1.2 [95% CI, 0.7-1.9]; P > .05) was associated with increased mortality risk. Infection caused by MRSA strains that were resistant to clindamycin and/or trimethoprim-sulfamethoxazole increased the mortality risk by 40% (HR, 1.4 [95% CI, 0.9-2.2]; P > .05), compared with the mortality risk of control subjects, but the increase was not statistically significant. MRSA infection independently increased length of stay by 40 days (95% CI, 34.2—45.6; P < .001) and was associated with an extra charge of $164,301 (95% CI, $158,712-$169,889; P < .001).

Conclusions.

MRSA colonization or infection in infants is associated with significant morbidity and financial burden but is not independently associated with increased mortality.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 2 , February 2010 , pp. 177 - 182
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes R; National Nosocomial Infections Surveillance System. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389–391.Google Scholar
2.Klevens, RM, Edwards, JR, Richards, CL Jr, et al.Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122(2):160–166.Google Scholar
3.Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns—Chicago and Los Angeles County, 2004. MMWR Morb Mortal Wkly Rep 2006;55(12):329–332.Google Scholar
4.Hitomi, S, Kubota, M, Mori, N, et al.Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by un-selective use of nasal mupirocin ointment. J Hosp Infect 2000;46(2):123–129.Google Scholar
5.Khoury, J, Jones, M, Grim, A, Dunne, WM Jr, Fraser, V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26(7):616–621.CrossRefGoogle ScholarPubMed
6.Nambiar, S, Herwaldt, LA, Singh, N. Outbreak of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med 2003;4(2):220–226.CrossRefGoogle ScholarPubMed
7.McDonald, JR, Carriker, CM, Pien, BC, et al.Methicillin-resistant Staphylococcus aureus outbreak in an intensive care nursery: potential for interinstitutional spread. Pediatr Infect Dis J 2007;26(8):678–683.CrossRefGoogle Scholar
8.Morel, AS, Wu, F, Della-Latta, P, Cronquist, A, Rubenstein, D, Saiman, L. Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants. Am J Infect Control 2002;30(3):170–173.CrossRefGoogle ScholarPubMed
9.Al-Tawfiq, JA. Father-to-infant transmission of community-acquired methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2006;27(6):636–637.Google Scholar
10.Mean, M, Mallaret, MR, Andrini, P, et al.A neonatal specialist with recurrent methicillin-resistant Staphylococcus aureus (MRSA) carriage implicated in the transmission of MRSA to newborns. Infect Control Hosp Epidemiol 2007;28(5):625–628.CrossRefGoogle ScholarPubMed
11.Bertin, ML, Vinski, J, Schmitt, S, et al.Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 2006;27(6):581–585.Google Scholar
12.Saiman, L, Cronquist, A, Wu, F, et al.An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24(5):317–321.Google Scholar
13.Behari, P, Englund, J, Alcasid, G, Garcia-Houchins, S, Weber, SG. Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk. Infect Control Hosp Epidemiol 2004;25(9):778–780.Google Scholar
14.Andersen, BM, Lindemann, R, Bergh, K, et al.Spread of methicü1in-resistant Staphylococcus aureus in a neonatal intensive unit associated with under-staffing, overcrowding and mixing of patients. J Hosp Infect 2002;50(1):18–24.CrossRefGoogle Scholar
15.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(Suppl 2):S82–S89.Google Scholar
16.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 2009;28(7):577–581.Google Scholar
17.Popovich, K, Hota, B, Rice, T, Aroutcheva, A, Weinstein, RA. Phenotypic prediction rule for community-associated methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2007;45(7):2293–2295.CrossRefGoogle ScholarPubMed
18.Newborn guidelines. In: International Classification of Diseases. Ver 9.0. Geneva, Switzerland: World Health Organization, 2009.Google Scholar
19.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 20O8;36(5):3O9–332.CrossRefGoogle Scholar
20.Harris, AD, Karchmer, TB, Carmeli, Y, Samore, MH. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 2001;32(7):1055–1061.Google Scholar
21.Wyllie, DH, Crook, DW, Peto, TE. Mortality after Staphylococcus aureus bacteraemia in two hospitals in Oxfordshire, 1997-2003: cohort study. BMJ 2006;333(7562):281.Google Scholar
22.Pollack, MM, Koch, MA, Bartel, DA, et al.A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000;105(5):1051–1057.Google Scholar
23.Kim, YH, et al.Clinical outcomes in methicillin-resistant Staphylococcus aurews-colonized neonates in the neonatal intensive care unit. Neonatology 2007;91(4):241–247.CrossRefGoogle ScholarPubMed
24.Denniston, S, Riordan, FA. Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review. J Infect 2006;53(6):387–393.Google Scholar
25.Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureusin long-term carriers. Clin Infect Dis 2008;47(2):176–181.CrossRefGoogle Scholar
26.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51(2): 126–132.Google Scholar