Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-15T03:52:18.926Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology of Methicillin-Susceptible Staphylococcus Aureus in the Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Philip L. Graham III ,
Anne-Sophie Morel ,
Juyan Zhou ,
Fann Wu ,
Phyllis Della-Latta ,
David Rubenstein  and
Lisa Saiman
Philip L. Graham III
Affiliation:
Department of Pediatrics, Columbia University, New York, New York
Anne-Sophie Morel
Affiliation:
Department of Pediatrics, Columbia University, New York, New York
Juyan Zhou
Affiliation:
Department of Pediatrics, Columbia University, New York, New York
Fann Wu
Affiliation:
Department of Pathology, Columbia University, New York, New York
Phyllis Della-Latta
Affiliation:
Department of Pathology, Columbia University, New York, New York
David Rubenstein
Affiliation:
Department of Pediatrics, Columbia University, New York, New York
Lisa Saiman*
Affiliation:
Department of Pediatrics, Columbia University, New York, New York Department of Epidemiology, Columbia University, New York, New York
*
Department of Pediatrics, Columbia University, 622 W. 168th St., PH 4 West Rm. 470 New York, NY 10032
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

When the incidence of methicillin-susceptible Staphylococcus aureus (MSSA) infection or colonization increased in our neonatal intensive care unit (NICU), we sought to further our understanding of the relationship among colonization with MSSA, endemic infection, and clonal spread.

Design:

A retrospective cohort study was used to determine risk factors for acquisition of a predominant clone of MSSA (clone “B”).

Setting:

A 45-bed, university-affiliated, level III-IV NICU.

Patients:

Infants hospitalized in the NICU from October 1999 to September 2000.

Interventions:

Infection control strategies included surveillance cultures of infants, cohorting infected or colonized infants, contact precautions, universal glove use, mupirocin treatment of the anterior nares of all infants in the NICU, and a hexachlorophene bath for infants weighing 1,500 g or more.

Results:

During the 1-year study period, three periods of increased incidence of MSSA colonization or infection, ranging from 6.4 to 13.5 cases per 1,000 patient-days per month, were observed. Molecular typing using pulsed-field gel electrophoresis demonstrated two predominant clones, clone “B” and clone “G,” corresponding to two periods of increased incidence. Multivariate analysis demonstrated that length of stay (OR, 1.035; 95% confidence interval [CI95], 1.008 to 1.062; P = .010) (increased risk per day) and the use of H2-blockers (OR, 20.44; CI95, 2.48 to 168.26; P = .005) were risk factors for either colonization or infection with clone “B,” and that the use of peripheral catheters was protective (OR, 0.06; CI95, 0.01 to 0.43; P = .005).

Conclusions:

Control of MSSA represents unique challenges as colonization is expected, endemic infections are tolerated, and surveillance efforts generally focus on multidrug-resistant pathogens. Future studies should address cost-effective surveillance strategies for endemic infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 677 - 682
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.La Gamma, EF, Drusin, LM, Mackles, AW, Machalek, S, Auld, PA. Neonatal infections: an important determinant of late NICU mortality in infants less than 1,000g at birth. American Journal of Diseases in Children 1983;137:838–841.CrossRefGoogle Scholar
2.Gaynes, R, Edwards, J, Jarvis, W, Culver, D, Tolson, J, Martone, W. The National Nosocomial Infections Surveillance System: nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357–361.CrossRefGoogle ScholarPubMed
3.Stoll, BJ, Gordon, T, Korones, SB, et al. Late onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:63–71.CrossRefGoogle ScholarPubMed
4.Haddad, Q. Sobayo, E, Basit, OBA, Rotimi, VO. Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Hosp Infect 1993;23:211–222.CrossRefGoogle Scholar
5.Tan, KW, Tay, L, Lim, SH. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in Singapore: a 20-month study of clinical characteristics and control. Singapore Med J 1994;35:277–282.Google Scholar
6.Reboli, AC, John, JF Jr, Levkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. American Journal of Diseases in Children 1989;143:34–39.Google Scholar
7.Campbell, JR, Zaccaria, E, Mason, EO Jr, Baker, CJ. Epidemiological analysis defining concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1998;19:924–928.CrossRefGoogle Scholar
8.Nakashima, AK, Allen, JR, Martone, WJ, et al. Epidemic bullous impetigo in a nursery due to a nasal carrier of Staphylococcus aureus: role of epidemiology and control measures. Infect Control 1984;5:326–331.CrossRefGoogle Scholar
9.Hargiss, C, Larson, E. The epidemiology of Staphylococcus aureus in a newborn nursery from 1970 through 1976. Pediatrics 1978;61:348–353.Google Scholar
10.Chowdhury, MN, Kambal, AM. An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit. J Hosp Infect 1992;22:299–305.CrossRefGoogle Scholar
11.Eriksson, M, Melen, B, Myrback, KE, Winbladh, B, Zetterstrom, R. Bacterial colonization of newborn infants in a neonatal intensive care unit. Acta Paediatr Scand 1982;71:779–783.CrossRefGoogle Scholar
12.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: Eleventh Informational Supplement. Wayne, PANational Committee for Clinical Laboratory Standards; 2001. M100–S11.Google Scholar
13.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;30:170–173.CrossRefGoogle ScholarPubMed
14.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
15.Satoshi, I, Ohta, M, Shimokata, K, Kato, N, Takeuchi, J. Genomic DNA fingerprinting by pulsed-field gel electrophoresis as an epidemiological marker for study of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1991;29:2690–2695.Google Scholar
16.Dominguez, M, Lencastre, H, Linares, J, Tomasz, A. Spread and maintenance of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone during an outbreak of MRSA disease in a Spanish hospital. J Clin Microbiol 1994;32:2081–2087.CrossRefGoogle Scholar
17.Krynski, S, Niemiro, A, Kamienska, K, Lukasik, J, Beda, E. Instability of the staphylococcal flora in a maternity hospital ward. Journal of Hygiene, Epidemiology, Microbiology, and Immunology 1965;9:169–179.Google Scholar
18.Shinefield, H. Staphylococcal infections. In: Remington, J, Klein, J, eds. Infectious Diseases of the Fetus and Newborn Infant, 4th ed. Philadelphia: W. B. Saunders; 1995:1111–1112.Google Scholar
19.Gooch, J, Britt, E. Staphylococcus aureus colonization and infection in newborn nursery patients. American Journal of Diseases in Children 1978;132:893–896.Google ScholarPubMed
20.Waldvogel, F. Staphylococcus aureus (including staphylococcal toxic shock). In: Mandell, G, Bennett, J, Dolin, R, eds. Principles and Practice of Infectious Diseases, 5th ed. Philadelphia: Churchill Livingstone; 2000:2069–2089.Google Scholar
21.Lowy, F. Staphylococcus aureus infections. N Engl J Med 1998;339:520–532.CrossRefGoogle ScholarPubMed
22.Corbella, X, Dominguez, MA, Pujol, M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16:351–357.CrossRefGoogle ScholarPubMed
23.Von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001; 344:11–16.CrossRefGoogle ScholarPubMed
24.Weber, S, Herwaldt, LA, McNutt, L-A, et al. An outbreak of Staphylococcus aureus in a pediatric cardiothoracic surgery unit. Infect Control Hosp Epidemiol 2002;23:77–81.CrossRefGoogle Scholar
25.Villari, P, Iacuzio, L, Torre, I, Scarcella, A. Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit. J Infect 1998;37:274–281.CrossRefGoogle ScholarPubMed
26.Kawagoe, JY, Segre, CA, Pereira, CR, Cardoso, MF, Silva, CV, Fukushima, JT. Risk factors for nosocomial infections in critically ill newborns: a 5-year prospective cohort study. Am J Infect Control 2001;29:109–114.CrossRefGoogle ScholarPubMed
27.Driks, M, Craven, D, Celli, B, et al. Nosocomial pneumonia in intubated patients given sulcralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 1987;317:1376–1382.CrossRefGoogle ScholarPubMed
28.Beck-Sague, C, Azimi, P, Fonseca, S, et al. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J 1994;13:1110–1116.CrossRefGoogle ScholarPubMed
29.Saiman, L, Ludington, E, Pfaller, M, et al. Risk factors for candidemia in neonatal intensive care unit patients. Pediatr Infect Dis J 2001;20:1119–1124.CrossRefGoogle ScholarPubMed
30.Saiman, L, Ludington, E, Dawson, JD, et al. Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J.In press.Google Scholar
31.Weber, J, Angstwurm, K, Rosenkranz, T, et al. Histamine (H1) receptor antagonist inhibits leukocyte rolling in pial vessels in the early phase of bacterial meningitis in rats. Neurosci Lett 1997;226:17–20.CrossRefGoogle ScholarPubMed
32.Finelli, L, Livengood, JR, Saiman, L. Surveillance of pharyngeal colonization: detection and control of serious bacterial illness in low birth weight infants. Pediatr Infect Dis J 1994;13:854–359.CrossRefGoogle ScholarPubMed
33.Kluytmans, J, Van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.CrossRefGoogle ScholarPubMed