1
|
Partha SS, Malone SM, Bizzle M, Ikpeama G, Reich PJ, Schuetz CR, Fritz SA. Healthcare worker perceptions surrounding Staphylococcus aureus transmission and prevention practices in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2023; 44:1953-1958. [PMID: 37272454 PMCID: PMC10755153 DOI: 10.1017/ice.2023.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To understand healthcare worker (HCW) perceptions surrounding Staphylococcus aureus transmission and prevention in the neonatal intensive care unit (NICU). DESIGN Qualitative case study with focus groups. SETTING A level IV, 150-bed NICU at a Midwestern academic medical center that conducts active surveillance and decolonization of S. aureus-positive patients. PARTICIPANTS NICU HCWs, including bedside nurses, nurse managers, therapy services personnel, pediatric nurse practitioners, clinical fellows, and attending neonatologists. METHODS Semistructured focus group interviews, assembled by occupation, were conducted by 2 study team members. Interviews were video recorded and transcribed. Deductive coding and thematic analyses were performed using NVivo software. RESULTS In total, 38 HCWs participated in 10 focus groups (1-12 participants each), lasting 40-90 minutes. Four main themes emerged: (1) Methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are inconsistently described as high risk. (2) Infection prevention interventions are burdensome. (3) Multiple sources of transmission are recognized. (4) opportunities exist to advance infection prevention. HCWs perceived MSSA to be less clinically relevant than MRSA. Participants expressed a desire to see published data supporting infection prevention interventions, including contact precautions, environmental cleaning, and patient decolonization. These practices were identified to be considerable burdens. HCWs perceived families to be the main source of S. aureus in the NICU, and they suggested opportunities for families to play a larger role in infection prevention. CONCLUSIONS These data highlight opportunities for HCW and parental education, research, and reevaluating interventions aimed at improving infection prevention efforts to reduce the burden of S. aureus in NICU settings.
Collapse
Affiliation(s)
- Samik S. Partha
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Sara M. Malone
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | | | | | - Patrick J. Reich
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Carly R. Schuetz
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| |
Collapse
|
2
|
Li XC, Sun L, Li T. Neonatal methicillin-resistant Staphylococcus aureus pneumonia-related recurrent fatal pyopneumothorax: A case report and review of literature. World J Clin Cases 2023; 11:7475-7484. [PMID: 37969452 PMCID: PMC10643081 DOI: 10.12998/wjcc.v11.i30.7475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Although neonatal Staphylococcus aureus pneumonia is common and usually curable, it can also be refractory and life-threatening. Herein, we report a case of severe neonatal community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) necrotizing pneumonia with bilateral recurrent pyopneumothorax, respiratory failure, heart failure, and cardiac arrest. We hope our report will add to the understanding of this disease. CASE SUMMARY An 18-d-old boy presented with cough for five days, fever for three days, and dyspnea for two days. Preadmission chest radiograph revealed high-density shadows in both lungs. On admission, his oxygen saturation fluctuated around 90% under synchronized intermittent mandatory ventilation. He was unconscious, with dyspnea, weak heart sounds and hepatomegaly. Moist crackles were present throughout his left lung, while the breath sounds in the right lung were decreased. After high-frequency oscillatory ventilation, empiric antimicrobials (meropenem and vancomycin), improved circulation, and right pleural cavity drainage for right pneumothorax (approximately 90% compression), his oxygen saturation level stayed above 95%, and recruitment of the right lung was observed. His condition did not deteriorate until the 5th day of hospitalization (DOH 5). On the morning of DOH 5, his oxygen saturation decreased. Subsequent chest radiograph showed bilateral pneumothorax with nearly 100% compression of the left lung. Desaturation was not relieved after urgent left pleural cavity drainage, and cardiac arrest occurred soon thereafter. Although his spontaneous heartbeat returned through emergency resuscitation and salvage antibacterial therapy (linezolid and levofloxacin) was administered given the detection and antimicrobial susceptibility of MRSA, he showed no improvement, with recurrent pyopneumothorax and continued drainage of purulent fluid and necrotic lung tissue fragments from the pleural cavity. Eventually, his parents refused extracorporeal membrane oxygenation (ECMO) and gave up all the treatments, and the newborn passed away soon after withdrawal on DOH 13. CONCLUSION Neonatal MRSA pneumonia can be refractory and lethal, especially in cases where necrotizing pneumonia leads to extensive lung necrosis and recurrent pneumothorax. Despite treatment with linezolid and other medical measures, it may still be ineffective. Currently, ECMO has been a remedial therapy, but if the lung tissue is too severely eroded to be repaired, it may be useless unless the infection can be controlled and lung transplantation can be performed. Regardless of whether ECMO is initiated, the key to successful treatment is to achieve control over the pneumonia caused by MRSA as soon as possible and to reverse lung injury as much as possible.
Collapse
Affiliation(s)
- Xing-Chao Li
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Li Sun
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Tao Li
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| |
Collapse
|
3
|
Brachio SS, Gu W, Saiman L. Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:381-397. [PMID: 37201987 DOI: 10.1016/j.clp.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We discuss the burden of health care-associated infections (HAIs) in the neonatal ICU and the role of quality improvement (QI) in infection prevention and control. We examine specific QI opportunities and approaches to prevent HAIs caused by Staphylococcus aureus , multidrug-resistant gram-negative pathogens, Candida species, and respiratory viruses, and to prevent central line-associated bloodstream infections (CLABSIs) and surgical site infections. We explore the emerging recognition that many hospital-onset bacteremia episodes are not CLABSIs. Finally, we describe the core tenets of QI, including engagement with multidisciplinary teams and families, data transparency, accountability, and the impact of larger collaborative efforts to reduce HAIs.
Collapse
Affiliation(s)
- Sandhya S Brachio
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA.
| | - Wendi Gu
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH1-470, New York, NY 10032, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
4
|
A tale of two intensive care units (ICUs): Baseline Staphylococcus aureus colonization and mupirocin susceptibility in neonatal and pediatric patients requiring intensive care. Infect Control Hosp Epidemiol 2023; 44:447-452. [PMID: 35450544 PMCID: PMC10015265 DOI: 10.1017/ice.2022.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the incidence rate of S. aureus colonization at baseline along with the mupirocin susceptibility (or resistance) rate in patients in a neonatal intensive care unit (NICU) and a pediatric intensive care unit (PICU) in conjunction with the implementation of universal decolonization as the standard of care. DESIGN Prospective cohort study. SETTING Children's Hospital of Michigan (CHM) inpatient intensive care units (ICUs). PARTICIPANTS Newly admitted pediatric patients to the CHM NICU or PICU aged between 1 day and ≤21 years. INTERVENTIONS Baseline and follow-up S. aureus screening cultures were obtained before patients underwent universal decolonization with mupirocin 2% antibiotic ointment (intranasal and umbilical) and chlorhexidine baths as standard of care to reduce CLABSI rates. RESULTS Baseline S. aureus colonization rates of new admissions to the CHM NICU and PICU were high at 32% and 29%, respectively. Baseline mupirocin susceptibility to any S. aureus growth was 98.4%. All baseline culture isolates whether positive for MRSA or MSSA, with one exception, had minimum inhibitory concentrations (MICs) of ≤0.19 µg/mL. All follow-up study cultures after universal decolonization at 7 days or beyond with any S. aureus growth had mupirocin MICs of ≤0.125 µg/mL. CONCLUSIONS Baseline S. aureus colonization rates of new admissions to the CHM ICUs were high as was baseline mupirocin susceptibility. Follow-up cultures, albeit limited in number, did not detect increasing mupirocin MICs over 1 year, despite broad mupirocin exposure due to the implementation of universal decolonization.
Collapse
|
5
|
Barrett RE, Fleiss N, Hansen C, Campbell MM, Rychalsky M, Murdzek C, Krechevsky K, Abbott M, Allegra T, Blazevich B, Dunphy L, Fox A, Gambardella T, Garcia L, Grimm N, Scoffone A, Bizzarro MJ, Murray TS. Reducing MRSA Infection in a New NICU During the COVID-19 Pandemic. Pediatrics 2023; 151:190449. [PMID: 36625072 DOI: 10.1542/peds.2022-057033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in most NICUs, with a high rate of skin colonization and subsequent invasive infections among hospitalized neonates. The effectiveness of interventions designed to reduce MRSA infection in the NICU during the coronavirus disease 2019 (COVID-19) pandemic has not been characterized. METHODS Using the Institute for Healthcare Improvement's Model for Improvement, we implemented several process-based infection prevention strategies to reduce invasive MRSA infections at our level IV NICU over 24 months. The outcome measure of invasive MRSA infections was tracked monthly utilizing control charts. Process measures focused on environmental disinfection and hospital personnel hygiene were also tracked monthly. The COVID-19 pandemic was an unexpected variable during the implementation of our project. The pandemic led to restricted visitation and heightened staff awareness of the importance of hand hygiene and proper use of personal protective equipment, as well as supply chain shortages, which may have influenced our outcome measure. RESULTS Invasive MRSA infections were reduced from 0.131 to 0 per 1000 patient days during the initiative. This positive shift was sustained for 30 months, along with a delayed decrease in MRSA colonization rates. Several policy and practice changes regarding personnel hygiene and environmental cleaning likely contributed to this reduction. CONCLUSIONS Implementation of a multidisciplinary quality improvement initiative aimed at infection prevention strategies led to a significant decrease in invasive MRSA infections in the setting of the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Noa Fleiss
- Yale School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | - Meaghan Abbott
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Terese Allegra
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Beth Blazevich
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Louise Dunphy
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Amy Fox
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | | | - Lindsey Garcia
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Natalie Grimm
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Amy Scoffone
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | | | - Thomas S Murray
- Yale School of Medicine, New Haven, Connecticut.,Yale New Haven Children's Hospital, New Haven, Connecticut
| |
Collapse
|
6
|
Genomic and Epidemiological Features of Two Dominant Methicillin-Susceptible Staphylococcus aureus Clones from a Neonatal Intensive Care Unit Surveillance Effort. mSphere 2022; 7:e0040922. [PMID: 36218345 PMCID: PMC9769867 DOI: 10.1128/msphere.00409-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) is a more prevalent neonatal intensive care unit (NICU) pathogen than methicillin-resistant S. aureus (MRSA). However, the introduction and spread of MSSA, the role of systematic decolonization, and optimal infection prevention and control strategies remain incompletely understood. We previously screened infants hospitalized in a university-affiliated level III to IV NICU twice monthly over 18 months for S. aureus colonization and identified several prevalent staphylococcal protein A (spa) types. Here, we performed whole-genome sequencing (WGS) and phylogenetic comparisons of 140 isolates from predominant spa types t279, t1451, and t571 to examine possible transmission routes and identify genomic and epidemiologic features associated with the spread of dominant clones. We identified two major MSSA clones: sequence type 398 (ST398), common in the local community, and ST1898, not previously encountered in the region. ST398 NICU isolates formed distinct clusters with closely related community isolates from previously published data sets, suggesting multiple sources of acquisition, such as family members or staff, including residents of the local community. In contrast, ST1898 isolates were nearly identical, pointing to clonal expansion within the NICU. Almost all ST1898 isolates harbored plasmids encoding mupirocin resistance (mupA), suggesting an association between the proliferation of this clone and decolonization efforts with mupirocin. Comparative genomics indicated genotype-specific pathways of introduction and spread of MSSA via community-associated (ST398) or health care-associated (ST1898) sources and the potential role of mupirocin resistance in dissemination of ST1898. Future surveillance efforts could benefit from routine genotyping to inform clone-specific infection prevention strategies. IMPORTANCE Methicillin-susceptible Staphylococcus aureus (MSSA) is a significant pathogen in neonates. However, surveillance efforts in neonatal intensive care units (NICUs) have focused primarily on methicillin-resistant S. aureus (MRSA), limiting our understanding of colonizing and infectious MSSA clones which are prevalent in the NICU. Here, we identify two dominant colonizing MSSA clones during an 18-month surveillance effort in a level III to IV NICU, ST398 and ST1898. Using genomic surveillance and phylogenetic analysis, coupled with epidemiological investigation, we found that these two sequence types had distinct modes of spread, namely the suggested exchange with community reservoirs for ST398 and the contribution of antibiotic resistance to dissemination of ST1898 in the health care setting. This study highlights the additional benefits of whole-genome surveillance for colonizing pathogens, beyond routine species identification and genotyping, to inform targeted infection prevention strategies.
Collapse
|
7
|
Toyama Y, Hisata K, Kasai Y, Nakano S, Komatsu M, Shimizu T. Molecular epidemiology of methicillin-sensitive Staphylococcus aureus in the neonatal intensive care unit. J Hosp Infect 2022; 129:75-81. [PMID: 35987317 DOI: 10.1016/j.jhin.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Staphylococcus aureus-both meticillin-resistant S. aureus (MRSA) and meticillin-sensitive S. aureus (MSSA)-is a major cause of neonatal infections. Infection control measures have not lowered the incidence of MSSA infections to the same degree as that of MRSA infections. AIM To investigate the transmission pathway of MSSA in neonatal intensive care unit (NICU) using genetic analysis. METHODS We swab-tested neonatal patients, their parents, and healthcare workers (HCW) in the NICU at our hospital at the time of hospitalisation and then every month thereafter from 1st October 2018 to 31st March 2019. We performed whole-genome sequencing (WGS) to test for MSSA strains. Multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis were used to identify strains and understand their relatedness. FINDINGS There were 16 MSSA-positive patients. Four MSSA-positive patients shared strains from the same phylogenetic groups as those of HCW. One presented the same strain as the parent. MSSA-positive twin neonates shared the same strain. Ten had sporadic strains; 32 of the ninety-seven tested healthcare workers were MSSA positive. CONCLUSION The findings of this study suggest that the route of transmission of MSSA in NICU may be through MSSA in the hospital environment in addition to horizontal transmission via healthcare workers. Along with hand hygiene with alcohol, thorough environmental maintenance and parental education are important for infection control in NICUs targeting MSSA.
Collapse
Affiliation(s)
- Yudai Toyama
- Department of Pediatrics and Adolescent Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ken Hisata
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan.
| | - Yuriha Kasai
- Department of Pediatrics and Adolescent Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Saki Nakano
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatrics, Tokyo Rinkai Hospital, Tokyo, Japan
| | - Mitsutaka Komatsu
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
8
|
Nelson MU, Shaw J, Gross SJ. Randomized Placebo-Controlled Trial of Topical Mupirocin to Reduce Staphylococcus aureus Colonization in Infants in the Neonatal Intensive Care Unit. J Pediatr 2021; 236:70-77. [PMID: 34023342 DOI: 10.1016/j.jpeds.2021.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the efficacy of topical mupirocin in reducing Staphylococcus aureus colonization in infants in the neonatal intensive care unit (NICU). STUDY DESIGN A prospective double-blind randomized controlled trial of mupirocin vs placebo in S aureus-colonized infants was conducted in a tertiary care NICU between October 2016 and December 2019. Weekly universal active surveillance with polymerase chain reaction screening identified colonized infants. Colonized infants received a 5-day course of mupirocin (mupirocin group) or petroleum jelly (control group). Repeat courses were given for additional positive screens. RESULTS A total of 216 infants were enrolled; 205 were included in data analyses. Primary decolonization was more successful for mupirocin-treated infants (86 of 104 [83%]) than for controls (20 of 101; 20%) (P < .001). Although recurrent S aureus colonization occurred frequently (59 of 81 [73%] mupirocin-treated and 26 of 33 [79%] controls), subsequent decolonization remained more successful for mupirocin-treated infants than for controls (38 of 49 [78%] vs 2 of 21 [10%]; P < .001). Subgroup analyses of infants of ≤30 weeks' gestational age yielded similar results; decolonization occurred more often in mupirocin-treated infants compared with control infants (63 of 76 [83%] vs 13 of 74 [18%]; P < .001). Bacterial sterile site infections tended to be less frequent in mupirocin-treated infants compared with controls (2 of 104 [2%] vs 8 of 101 [8%]; P = .057). No invasive S aureus infections occurred in mupirocin-treated infants, but 50% of infections in controls were from S aureus, and 1 resulted in death. CONCLUSIONS Universal active surveillance and targeted treatment with topical mupirocin is a successful decolonization strategy for NICU infants and may prevent S aureus infection. However, S aureus colonization frequently recurs, necessitating repeat treatment. TRIAL REGISTRATION Clinicaltrials.gov: NCT02967432.
Collapse
Affiliation(s)
- Melissa U Nelson
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY; Department of Neonatology, Crouse Hospital, Syracuse, NY.
| | - Jana Shaw
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY
| | - Steven J Gross
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY; Department of Neonatology, Crouse Hospital, Syracuse, NY
| |
Collapse
|
9
|
Holm MKA, Winther TN, Kammann S, Rasmusson MS, Brooks L, Westh H, Bartels MD. Prevalence of MRSA nasal carriage among pregnant women in Copenhagen. PLoS One 2021; 16:e0246343. [PMID: 33513178 PMCID: PMC7845946 DOI: 10.1371/journal.pone.0246343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background Methicillin resistant Staphylococcus aureus (MRSA) frequently causes outbreaks in neonatal intensive care units (NICUs). It is believed that MRSA predominantly enters the NICU with MRSA colonized parents. In Denmark, 27 MRSA NICU outbreaks have been registered between 2008 and 2019. Aim The aim of this study was to determine the prevalence of MRSA nasal carriage in pregnant women in Copenhagen and to clarify if MRSA screening during pregnancy could add to the prevention of NICU outbreaks. Methods All pregnant women 18 years or older were offered MRSA nasal screening at their first midwife visit between 13 and 20 weeks of gestation. Results 1778 pregnant women were included, two (0.11%) carried MRSA in the nose. Conclusion Infants of the two MRSA positive women were not admitted to a NICU and therefore the screening had no impact on NICU outbreaks. The low prevalence of MRSA found in this study does not justify MRSA screening of all pregnant women in Denmark.
Collapse
Affiliation(s)
| | - Thilde Nordmann Winther
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Sisse Kammann
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Lis Brooks
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Westh
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Damkjær Bartels
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
10
|
Heigl K, Zamfir M, Adler AC, Dammeyer A, Schomacher L, Karlin B, Franitza M, Hörmansdorfer S, Tuschak C, Valenza G, Ochmann U, Herr C, Heinze S. Prevalence of methicillin-sensitive, methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase-producing Escherichia coli in newborns: a cross-sectional study. J Matern Fetal Neonatal Med 2020; 35:4243-4249. [PMID: 33207996 DOI: 10.1080/14767058.2020.1849100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prevalence of antimicrobial-resistant bacteria and methicillin-sensitive Staphylococcus aureus (MSSA) in healthy newborns and the role of maternal transmission are scarcely discussed. OBJECTIVES The objective of this study was to evaluate the prevalence of MSSA, MRSA, and ESBL among healthy newborns. Additionally, mother-to-newborn transmission rates were investigated as well as antibiotic susceptibility of MSSA, MRSA, and ESBL isolates. METHODS Swabs of 658 newborns and their mothers were collected to investigate the presence of MSSA, MRSA, and ESBL. Swabs were taken from the nose and umbilicus immediately after birth. Additional swabs were taken from the nose, perianal area, and umbilicus 3 days after birth. Samples were screened and further characterized using culture and molecular methods. RESULTS Prevalence of MSSA, MRSA, and ESBL colonization was 10.9, 0.5, and 2.6%, respectively. There was no association between the colonization status of the newborn and infections at any time point. Mother-to-newborn transmission rates (confirmed by PFGE) were 53.6% for MSSA/MRSA and 100% for ESBL. Maternal carriage of MSSA, MRSA, or ESBL was a risk factor for colonization of the newborn. Some isolates were resistant to the antibiotics recommended for therapy, including clindamycin and daptomycin for MSSA/MRSA isolates and ertapenem, fosfomycin, and tigecyclin for ESBL isolates. CONCLUSION No association between infections and the newborns' colonization status could be detected. Maternal colonization played an important role in newborn colonization, but not every case of colonization could be explained by mother-to-newborn transmission. General screening of pregnant women and healthy newborns in the absence of other risk factors is not necessary. To prevent the possibility of transmission in the healthcare setting, professionals, pregnant women, parents, hospital visitors, and obstetricians should receive regular training on appropriate hygiene measures. With regard to the emergence of resistance to recommended antibiotics, an antibiogram should be conducted before treating MSSA/MRSA/ESBL infections to ensure the efficacy of the antibiotics.
Collapse
Affiliation(s)
- Katharina Heigl
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Mihai Zamfir
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Alexandra C Adler
- Bavarian State Ministry of Public Health and Care Services, Munich, Germany
| | - Antchen Dammeyer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Lasse Schomacher
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Barbara Karlin
- Rotkreuzklinikum München, Women's Clinic, Munich, Germany
| | | | - Stefan Hörmansdorfer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Christian Tuschak
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Giuseppe Valenza
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Uta Ochmann
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - Caroline Herr
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - Stefanie Heinze
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| |
Collapse
|
11
|
Effect of Contact Precautions on Staphylococcus aureus and Clinical Outcomes of Colonized Patients in the Neonatal Intensive Care Unit. Pediatr Infect Dis J 2020; 39:1045-1049. [PMID: 33075218 DOI: 10.1097/inf.0000000000002795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Staphylococcus aureus is a common pathogen in neonatal intensive care units (NICUs), yet little is known about the effect of contact precautions and clinical outcomes of colonized patients. METHODS Retrospective cohort study of all neonates from August 2014 to November 2018 colonized with either methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA) and select noncolonized patients at two neonatal intensive care units at the University of California, Los Angeles. Outcomes during two time periods (during and after the use of contact precautions) were assessed. RESULTS A total of 234 patients were included in the study: 83 colonized and 151 noncolonized patients. There was a fourfold higher incidence of MSSA colonization versus MRSA (P < 0.001). There was a higher incidence of positive surveillance cultures after contact precautions were discontinued (P = 0.01), but this did not correlate with a higher incidence of invasive cultures (P = 0.475). There were twice as many MSSA invasive cultures than MRSA, but a higher rate of invasion with MRSA (P < 0.05). Colonized patients were more likely to develop an invasive infection than noncolonized (P = 0.003 MRSA; P = 0.004 MSSA). When controlling for gestational age and surgical interventions, colonization was more likely to be associated with skin and soft tissue infections (P < 0.001) and a longer length of stay by a mean of 27.8 days (P < 0.0001). CONCLUSIONS Contact precautions resulted in a lower incidence of colonization without a difference in invasive cultures in our NICUs. Those colonized with S. aureus had a higher incidence of skin and soft tissue infections and a longer NICU length of stay.
Collapse
|
12
|
Balamohan A, Beachy J, Kohn N, Rubin LG. The effect of routine surveillance and decolonization on the rate of Staphylococcus aureus infections in a level IV neonatal intensive care unit. J Perinatol 2020; 40:1644-1651. [PMID: 32772050 DOI: 10.1038/s41372-020-0755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the impact of active surveillance cultures (ASC) for Staphylococcus aureus (SA) and decolonization on the rate of infection in neonates in a neonatal intensive care unit (NICU). STUDY DESIGN Using a quasi-experimental design with control groups, rates of SA infections before and after implementing weekly ASC and topical mupirocin decolonization in a level IV NICU were compared. Comparators were the rates of gram negative bloodstream infections (BSI) and of SA BSI at an affiliated NICU where the intervention was not implemented. RESULT There was a 77% (p < 0.010) reduction in rate of NICU-wide methicillin-susceptible SA (MSSA) BSI, but no significant change in rate of methicillin-resistant SA BSI, likely due to a prevalent mupirocin-resistant clone. Rates of gram negative BSI and SA BSI at an affiliated NICU did not change significantly. CONCLUSION Weekly ASC and decolonization were associated with a unit-wide reduction in MSSA infections in a NICU.
Collapse
Affiliation(s)
- Archana Balamohan
- Cohen Children's Medical Center of New York, Northwell Health, New York, NY, USA.
| | - Joanna Beachy
- Cohen Children's Medical Center of New York, Northwell Health, New York, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Nina Kohn
- Biostatistics Unit, Feinstein Institute of Medical Research, Northwell Health, Manhasset, NY, USA
| | - Lorry G Rubin
- Cohen Children's Medical Center of New York, Northwell Health, New York, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
13
|
Molecular epidemiology of methicillin-susceptible Staphylococcus aureus in infants in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2020; 41:1402-1408. [PMID: 32935655 DOI: 10.1017/ice.2020.355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the molecular epidemiology of methicillin-susceptible Staphylococcus aureus (MSSA) in infants in a neonatal intensive care unit (NICU) using whole-genome sequencing. DESIGN Investigation of MSSA epidemiology in a NICU. SETTING Single-center, level IV NICU. METHODS Universal S. aureus screening was done using a single swab obtained from the anterior nares, axilla, and groin area of infants in the NICU on a weekly basis. Core genome multilocus sequence type (cgMLST) analysis was performed on MSSA isolates detected over 1 year (2018-2019). RESULTS In total, 68 MSSA-colonized infants were identified, and cgMLSTs of 67 MSSA isolates were analyzed. Overall, we identified 11 cgMLST isolate groups comprising 39 isolates (58%), with group sizes ranging from 2 to 10 isolates, and 28 isolates (42%) were unrelated to each other or any of the isolate groups. Cases of infants colonized by MSSA were scattered throughout the 1-year study period, and isolates belonging to the same cgMLST group were typically detected contemporaneously, over a few weeks or a few months. Overall, 13 infants (19.7%) developed MSSA infections: bacteremia (n = 3), wound infection (n = 5), conjunctivitis (n = 4), and cellulitis (n = 1). We detected no association between these clinically manifest infections and specific cgMLST groups. CONCLUSIONS Although MSSA isolates in infants in a NICU showed high diversity, most were related to other isolates, albeit within small groups. cgMLST facilitates an understanding of the complex transmission dynamics of MSSA in NICUs, and these data can be used to inform better control strategies.
Collapse
|
14
|
CORR Insights®: Does Preoperative Decolonization Reduce Surgical Site Infections in Elective Orthopaedic Surgery? A Prospective Randomized Controlled Trial. Clin Orthop Relat Res 2020; 478:1801-1804. [PMID: 32118604 PMCID: PMC7371087 DOI: 10.1097/corr.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
15
|
Slingerland BCGC, Vos MC, Bras W, Kornelisse RF, De Coninck D, van Belkum A, Reiss IKM, Goessens WHF, Klaassen CHW, Verkaik NJ. Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Resist Infect Control 2020; 9:39. [PMID: 32087747 PMCID: PMC7036242 DOI: 10.1186/s13756-020-0699-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Neonatal Staphylococcus aureus (S. aureus) bacteremia is an important cause of morbidity and mortality. In this study, we examined whether methicillin-susceptible S. aureus (MSSA) transmission and genetic makeup contribute to the occurrence of neonatal S. aureus bacteremia. METHODS A retrospective, single-centre study was performed. All patients were included who suffered from S. aureus bacteremia in the neonatal intensive care unit (NICU), Erasmus MC-Sophia, Rotterdam, the Netherlands, between January 2011 and November 2017. Whole-genome sequencing (WGS) was used to characterize the S. aureus isolates, as was also done in comparison to reference genomes. Transmission was considered likely in case of genetically indistinguishable S. aureus isolates. RESULTS Excluding coagulase-negative staphylococci (CoNS), S. aureus was the most common cause of neonatal bacteremia. Twelve percent (n = 112) of all 926 positive blood cultures from neonates grew S. aureus. Based on core genome multilocus sequence typing (cgMLST), 12 clusters of genetically indistinguishable MSSA isolates were found, containing 33 isolates in total (2-4 isolates per cluster). In seven of these clusters, at least two of the identified MSSA isolates were collected within a time period of one month. Six virulence genes were present in 98-100% of all MSSA isolates. In comparison to S. aureus reference genomes, toxin genes encoding staphylococcal enterotoxin A (sea) and toxic shock syndrome toxin 1 (tsst-1) were present more often in the genomes of bacteremia isolates. CONCLUSION Transmission of MSSA is a contributing factor to the occurrence of S. aureus bacteremia in neonates. Sea and tsst-1 might play a role in neonatal S. aureus bacteremia.
Collapse
Affiliation(s)
- Bibi C G C Slingerland
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Willeke Bras
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - René F Kornelisse
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dieter De Coninck
- BioMérieux SA, Data Analytics, Clinical Unit, Sint-Martens-Latem, Belgium
| | - Alex van Belkum
- BioMérieux SA, Clinical Unit, 38390, La Balme-les-Grottes, France
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wil H F Goessens
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Cremers AJH, Coolen JPM, Bleeker-Rovers CP, van der Geest-Blankert ADJ, Haverkate D, Hendriks H, Henriet SSV, Huynen MA, Kolwijck E, Liem D, Melchers WJG, Rossen JW, Zoll J, van Heijst A, Hopman J, Wertheim HFL. Surveillance-embedded genomic outbreak resolution of methicillin-susceptible Staphylococcus aureus in a neonatal intensive care unit. Sci Rep 2020; 10:2619. [PMID: 32060342 PMCID: PMC7021795 DOI: 10.1038/s41598-020-59015-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/22/2020] [Indexed: 01/14/2023] Open
Abstract
We observed an increase in methicillin-susceptible Staphylococcus aureus (MSSA) infections at a Dutch neonatal intensive care unit. Weekly neonatal MSSA carriage surveillance and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. Traditional clustering of MSSA isolates by spa typing and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections. We investigated whether whole-genome sequencing (WGS) of MSSA surveillance would provide additional evidence for transmission. MSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to WGS and bioinformatic analysis for identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. By measuring the genetic diversity in background surveillance, we defined transmission-level relatedness and identified isolates that had been unjustly assigned to clusters based on MLVA, while spa typing was concordant but of insufficient resolution. Detailing particular subsets of isolates provided evidence that HCWs were involved in multiple outbreaks, yet it alleviated concerns about one particular HCW. The improved resolution and accuracy of genomic outbreak analyses substantially altered the view on outbreaks, along with apposite measures. Therefore, inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference.
Collapse
Affiliation(s)
- A J H Cremers
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands.
| | - J P M Coolen
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - C P Bleeker-Rovers
- Department of Internal Medicine, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | | | - D Haverkate
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - H Hendriks
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - S S V Henriet
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - M A Huynen
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - E Kolwijck
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - D Liem
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - J W Rossen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Zoll
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - A van Heijst
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - J Hopman
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - H F L Wertheim
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| |
Collapse
|
17
|
Geng W, Qi Y, Li W, McConville TH, Hill-Ricciuti A, Grohs EC, Saiman L, Uhlemann AC. Epidemiology of Staphylococcus aureus in neonates on admission to a Chinese neonatal intensive care unit. PLoS One 2020; 15:e0211845. [PMID: 32053585 PMCID: PMC7018019 DOI: 10.1371/journal.pone.0211845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/14/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose Little is known about the molecular epidemiology of Staphylococcus aureus in Chinese neonatal intensive care units (NICUs). We describe the molecular epidemiology of S. aureus isolated from neonates on admission to Beijing Children's Hospital. Methods From May 2015-March 2016, nasal swabs were obtained on admission from 536 neonates. Cultures were also obtained from body sites with suspected infections. S. aureus isolates were characterized by staphylococcal chromosomal cassette (SCCmec) type, staphylococcal protein A (spa) type, multilocus sequence type (MLST), sasX gene, antimicrobial susceptibility and cytotoxicity. Logistic regression assessed risk factors for colonization. Results Overall, 92 (17%) infants were colonized with S. aureus and 20 (3.7%) were diagnosed with culture-positive S. aureus infection. Of the colonized infants, 70% (64/92) harbored methicillin-susceptible S. aureus (MSSA), 30% (28/92) harbored methicillin-resistant S. aureus (MRSA) while 70% (14/20) of infected infants were culture-positive for MRSA, 30% (6/20) were culture-positive for MSSA. Risk factors for colonization included female sex, age 7–28 days, higher birthweight (3270 IQR [2020–3655] grams) and vaginal delivery (p<0.05). The most common MRSA and MSSA clones were community-associated ST59-SCCmecIVa-t437 (60%) and ST188-t189 (15%), respectively. The sasX gene was not detected. Some MSSA isolates (16%) were penicillin-susceptible and some MRSA isolates (18%) were oxacillin-susceptible. MRSA and MSSA had similar cytotoxicity, but colonizing strains were less cytotoxic than strains associated with infections. Conclusions S. aureus colonization was common in infants admitted to our NICU and two community-associated clones predominated. Several non-modifiable risk factors for S. aureus colonization were identified. These results suggest that screening infants for S. aureus upon admission and targeting decolonization of high-risk infants and/or those colonized with high-risk clones could be useful to prevent transmission.
Collapse
Affiliation(s)
- Wenjing Geng
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- * E-mail:
| | - Yujie Qi
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wenting Li
- Respiratory Department, Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Thomas H. McConville
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Alexandra Hill-Ricciuti
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Emily C. Grohs
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| |
Collapse
|
18
|
Zapata H, Wahba A. Severe necrotizing pneumonia complicated by empyema in a neonate. Respir Med Case Rep 2020; 31:101248. [PMID: 33101896 PMCID: PMC7569210 DOI: 10.1016/j.rmcr.2020.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022] Open
Abstract
Necrotizing pneumonia is a severe complication of pneumonia, characterized by local destruction of lung tissue with development of multiple small cavities (abscesses) and may be associated with empyema. Empyema is an unusual complication in neonates with limited data reported. We present a healthy term neonate with late-onset sepsis caused by Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia due to severe necrotizing pneumonia associated with advanced stage empyema. To the best of our knowledge this is the youngest reported patient with multifocal lung abscesses associated with stage 2 empyema treated successfully without surgical intervention.
Collapse
|
19
|
Abstract
Staphylococcus aureus is an important pathogen responsible for nosocomial and community-acquired infections in humans, and methicillin-resistant S. aureus (MRSA) infections have continued to increase despite widespread preventative measures. S. aureus can colonize the female vaginal tract, and reports have suggested an increase in MRSA infections in pregnant and postpartum women as well as outbreaks in newborn nurseries. Currently, little is known about specific factors that promote MRSA vaginal colonization and subsequent infection. To study S. aureus colonization of the female reproductive tract in a mammalian system, we developed a mouse model of S. aureus vaginal carriage and demonstrated that both hospital-associated and community-associated MRSA isolates can colonize the murine vaginal tract. Immunohistochemical analysis revealed an increase in neutrophils in the vaginal lumen during MRSA colonization. Additionally, we observed that a mutant lacking fibrinogen binding adhesins exhibited decreased persistence within the mouse vagina. To further identify novel factors that promote vaginal colonization, we performed RNA sequencing to determine the transcriptome of MRSA growing in vivo during vaginal carriage at 5 h, 1 day, and 3 days postinoculation. Over 25% of the bacterial genes were differentially regulated at all time points during colonization compared to laboratory cultures. The most highly induced genes were those involved in iron acquisition, including the Isd system and siderophore transport systems. Mutants deficient in these pathways did not persist as well during in vivo colonization. These results reveal that fibrinogen binding and the capacity to overcome host nutritional limitation are important determinants of MRSA vaginal colonization.IMPORTANCE Staphylococcus aureus is an opportunistic pathogen able to cause a wide variety of infections in humans. Recent reports have suggested an increasing prevalence of MRSA in pregnant and postpartum women, coinciding with the increased incidence of MRSA infections in neonatal intensive care units (NICUs) and newborn nurseries. Vertical transmission from mothers to infants at delivery is a likely route of MRSA acquisition by the newborn; however, essentially nothing is known about host and bacterial factors that influence MRSA carriage in the vagina. Here, we established a mouse model of vaginal colonization and observed that multiple MRSA strains can persist in the vaginal tract. Additionally, we determined that MRSA interactions with fibrinogen and iron uptake can promote vaginal persistence. This study is the first to identify molecular mechanisms which govern vaginal colonization by MRSA, the critical initial step preceding infection and neonatal transmission.
Collapse
|
20
|
Lavie-Nevo K, Srigley JA, Al-Rawahi GN, Bone J, Osiovich H, Roberts A, Ting JY. Prevalence and clinical impact of methicillin-resistant Staphylococcus aureus colonization among infants at a level III neonatal intensive care unit. Am J Infect Control 2019; 47:1336-1339. [PMID: 31253554 DOI: 10.1016/j.ajic.2019.04.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a well-known nosocomial pathogen in neonatal intensive care unit (NICU) patients. Studies on the impact of MRSA colonization on neonatal morbidities are scarce. METHODS We conducted a 1:3 matched cohort study among infants with and without MRSA colonization, born between January 2010 and June 2014, in a tertiary NICU to review their demographic characteristics and outcomes. RESULTS During the study period, rates of MRSA colonization and bacteremia were found to be 0.68% and 0.10%, respectively. No differences in demographic characteristics, mortality, and major morbidities were identified among infants with and without MRSA colonization. CONCLUSIONS We reported a low rate of MRSA colonization in infants admitted to our NICU, without impact on mortality and inhospital morbidity. Further large-scale studies are needed to understand the implications and cost-effectiveness of active MRSA surveillance.
Collapse
Affiliation(s)
- Karen Lavie-Nevo
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - Jocelyn A Srigley
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey Bone
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Horacio Osiovich
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ashley Roberts
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Y Ting
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
21
|
Wisgrill L, Berger A, Waldhör T, Makristathis A, Assadian O, Rittenschober-Böhm J. Combination of Nasal and Expanded Skin Swabs Enhances the Detection Rate of Staphylococcus aureus Colonization in Premature Infants. Pediatr Infect Dis J 2019; 38:422-423. [PMID: 30882738 DOI: 10.1097/inf.0000000000002089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nasal cultures are commonly used to detect carriers of Staphylococcus aureus (SA) in infants. Combination of nasal and skin swabs has been shown to enhance the detection rate of SA colonization in adult hospitalized patients. Combining nasal swabs with expanded body skin swabs enhanced detection of SA colonization in premature infants in a tertiary care neonatal department.
Collapse
Affiliation(s)
- Lukas Wisgrill
- From the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine
| | - Angelika Berger
- From the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine
| | | | | | - Ojan Assadian
- Department of Infection Control and Hospital Hygiene, Medical University Vienna, Vienna, Austria
| | - Judith Rittenschober-Böhm
- From the Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine
| |
Collapse
|
22
|
Kotloff KL, Shirley DAT, Creech CB, Frey SE, Harrison CJ, Staat M, Anderson EJ, Dulkerian S, Thomsen IP, Al-Hosni M, Pahud BA, Bernstein DI, Yi J, Petrikin JE, Haberman B, Stephens K, Stephens I, Oler RE, Conrad TM. Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units. Pediatrics 2019; 143:peds.2018-1565. [PMID: 30587533 PMCID: PMC6317770 DOI: 10.1542/peds.2018-1565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5849573989001PEDS-VA_2018-1565Video Abstract BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of late-onset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants. METHODS Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed. RESULTS A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (P < .001). Twenty-one of 46 (45.7%) treated infants were persistently decolonized compared with 1 of 48 (2.1%) controls (P < .001). CONCLUSIONS Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized.
Collapse
Affiliation(s)
- Karen L. Kotloff
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | - Debbie-Ann T. Shirley
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | - C. Buddy Creech
- Vanderbilt Vaccine Research Program, Department of
Pediatrics, School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | | | - Mary Staat
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Evan J. Anderson
- Departments of Medicine and,Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | | | - Isaac P. Thomsen
- Vanderbilt Vaccine Research Program, Department of
Pediatrics, School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | | | - David I. Bernstein
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Jumi Yi
- Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | | | - Beth Haberman
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Kathy Stephens
- Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | - Ina Stephens
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | | | | |
Collapse
|
23
|
Semple A, O'Currain E, O'Donovan D, Hanahoe B, Keady D, Ní Riain U, Moylett E. Successful termination of sustained transmission of resident MRSA following extensive NICU refurbishment: an intervention study. J Hosp Infect 2018; 100:329-336. [PMID: 30009868 DOI: 10.1016/j.jhin.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/06/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neonatal sepsis is a leading cause of morbidity and mortality in neonatal units worldwide. Meticillin-resistant Staphylococcus aureus (MRSA) has become a leading causative pathogen. Many neonatal units experience endemic colonization and infection of their infants, which is often very challenging to successfully eradicate. AIM To assess the impact of neonatal unit refurbishment and redesign on endemic MRSA colonization and infection. METHODS A retrospective review was carried out over an eight-year period in a 14-cot, level 2-3 neonatal unit in University Hospital Galway, a large university teaching hospital in the West of Ireland. Surveillance, colonization, and infection data for a four-year period pre and four-year period post neonatal unit refurbishment are described. Clinical and microbiological data were collected on all MRSA-colonized and -infected infants between 2008 and 2015. Molecular typing data are available for MRSA isolates. An interrupted time-series design was used, with unit refurbishment as the intervention. FINDINGS Our neonatal unit had a pattern of sustained transmission of endemic resident MRSA strains which we could not eradicate despite repeated standard infection control interventions. Complete unit refurbishment led to successful termination of sustained transmission of these strains. Colonization decreased and no infants were actively infected post refurbishment of the unit. CONCLUSION We report successful termination of sustained transmission of endemic strains of MRSA from our neonatal unit following complete unit redesign and refurbishment.
Collapse
Affiliation(s)
- A Semple
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland.
| | - E O'Currain
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland
| | - D O'Donovan
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland
| | - B Hanahoe
- Division of Clinical Microbiology, University Hospital, Galway, Ireland
| | - D Keady
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - U Ní Riain
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - E Moylett
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland
| |
Collapse
|
24
|
Lin J, Wu C, Yan C, Ou Q, Lin D, Zhou J, Ye X, Yao Z. A prospective cohort study of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus carriage in neonates: the role of maternal carriage and phenotypic and molecular characteristics. Infect Drug Resist 2018; 11:555-565. [PMID: 29731644 PMCID: PMC5926071 DOI: 10.2147/idr.s157522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), in mothers can cause serious outcomes in neonates. We aimed to elucidate the associations of S. aureus and MRSA carriage between mothers and neonates. Methods A prospective cohort study was conducted between August and November 2015 in two hospitals in Shenzhen, China. Chinese pregnant women and their neonates who met the inclusion criteria were included in this study; samples and relevant information were collected. We assessed maternal–neonatal associations by using Poisson regression models. Results Overall, 1834 mothers and their neonates were included in this study. The prevalence of isolate carriage among the mothers was as follows: S. aureus (nasal, 25.8%; vaginal, 7.3%; and nasal and vaginal, 3.3%) and MRSA (nasal, 5.7%; vaginal, 1.7%; and nasal and vaginal, 0.5%). The incidences of S. aureus and MRSA carriage among neonates were 3.3% and 0.8%, respectively. Of the 21 maternal–neonatal pairs with S. aureus carriage, 14 were concordant pairs with the same phenotypic and molecular characteristics. After adjustment, the relative risks and 95% confidence intervals (CIs) between the S. aureus carriage of neonates and nasal S. aureus carriage, vaginal S. aureus carriage, and both nasal and vaginal S. aureus carriage of mothers were 2.8 (95% CI, 1.6–4.8), 7.1 (95% CI, 4.1–12.4), and 9.6 (95% CI, 4.2–22.4), respectively. Conclusion S. aureus carriage in mothers increases the risk for neonates.
Collapse
Affiliation(s)
- Jialing Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Chuanan Wu
- Maternal and Child Health Care Center of Longhua District, Shenzhen, China
| | - Chunrong Yan
- Maternal and Child Health Care Center of Longhua District, Shenzhen, China
| | - Qianting Ou
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Dongxin Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Junli Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaohua Ye
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhenjiang Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| |
Collapse
|
25
|
Identification and antimicrobial resistance of pathogens in neonatal septicemia in China-A meta-analysis. Int J Infect Dis 2018; 71:89-93. [PMID: 29689386 DOI: 10.1016/j.ijid.2018.04.794] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/06/2018] [Accepted: 04/13/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The purpose of this study was to analyze the distribution and antimicrobial resistance of common bacterial pathogens causing neonatal septicemia based on a systematic review of published studies in China. METHODS Articles on neonatal sepsis published in the Chinese literature from 2009 to 2014 were identified according to the inclusion and exclusion criteria. Data were extracted and analyzed using Comprehensive Meta-Analysis software. RESULTS A total of 71 studies were included, in which a total of 8080 bacterial species were isolated from culture-positive blood samples. The pooled distribution rates of common bacterial pathogens were as follows: Staphylococcus 67.1% (95% confidence interval (CI) 63.3-70.6%), Enterococcus 4.1% (95% CI 3.5-4.8%), Streptococcus 2.3% (95% CI 1.6-3.2%), Escherichia coli 7.4% (95% CI 6.4-8.7%), Klebsiella 6.5% (95% CI 5.2-8.2%), Enterobacterium 2.3% (95% CI 1.9-2.8%), Acinetobacter 1.6% (95% CI 1.3-2.0%), Pseudomonas 1.7% (95% CI 1.3-2.2%). Among the Staphylococcus aureus strains isolated, more than 60% were methicillin-resistant (MRSA). In addition, over 50% of the Gram-negative isolates, including Escherichia and Klebsiella, were resistant to the commonly used third-generation cephalosporins. Most of the Gram-positive and Gram-negative bacteria isolated were sensitive to aminoglycosides, especially amikacin. CONCLUSIONS It is concluded that Staphylococcus, especially coagulase-negative Staphylococcus, continues to be the principal organism responsible for neonatal septicemia in China; Enterobacteriaceae are common among the Gram-negative isolates. Significant numbers of MRSA and multidrug-resistant Gram-negative bacteria are being isolated as pathogens responsible for neonatal septicemia in China.
Collapse
|
26
|
Sass L, Karlowicz MG. Healthcare-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152335 DOI: 10.1016/b978-0-323-40181-4.00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
27
|
Doernberg SB, Lodise TP, Thaden JT, Munita JM, Cosgrove SE, Arias CA, Boucher HW, Corey GR, Lowy FD, Murray B, Miller LG, Holland TL. Gram-Positive Bacterial Infections: Research Priorities, Accomplishments, and Future Directions of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S24-S29. [PMID: 28350900 DOI: 10.1093/cid/ciw828] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antimicrobial resistance in gram-positive bacteria remains a challenge in infectious diseases. The mission of the Gram-Positive Committee of the Antibacterial Resistance Leadership Group (ARLG) is to advance knowledge in the prevention, management, and treatment of these challenging infections to improve patient outcomes. Our committee has prioritized projects involving methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) due to the scope of the medical threat posed by these pathogens. Approved ARLG projects involving gram-positive pathogens include (1) a pharmacokinetics/pharmacodynamics study to evaluate the impact of vancomycin dosing on patient outcome in MRSA bloodstream infection (BSI); (2) defining, testing, and validating innovative assessments of patient outcomes for clinical trials of MRSA-BSI; (3) testing new strategies for "step-down" antibiotic therapy for MRSA-BSI; (4) management of staphylococcal BSIs in neonatal intensive care units; and (5) defining the impact of VRE bacteremia and daptomycin susceptibility on patient outcomes. This article outlines accomplishments, priorities, and challenges for research of infections caused by gram-positive organisms.
Collapse
Affiliation(s)
- Sarah B Doernberg
- Division of Infectious Diseases, University of California, San Francisco
| | | | - Joshua T Thaden
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Jose M Munita
- Division of Infectious Diseases, University of Texas Health Sciences Center, Houston.,Clinica Alemana, Universidad del Desarrollo, Chile
| | - Sara E Cosgrove
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, University of Texas Health Sciences Center, Houston
| | - Helen W Boucher
- Division of Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - G Ralph Corey
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Franklin D Lowy
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York
| | - Barbara Murray
- Division of Infectious Diseases, University of Texas Health Sciences Center, Houston
| | - Loren G Miller
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; and
| | - Thomas L Holland
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
28
|
Risk Factors for Staphylococcus aureus Acquisition in the Neonatal Intensive Care Unit: A Matched Case-Case-Control Study. Infect Control Hosp Epidemiol 2017; 39:46-52. [PMID: 29157314 DOI: 10.1017/ice.2017.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine risk factors independent of length of stay (LOS) for Staphylococcus aureus acquisition in infants admitted to the neonatal intensive care unit (NICU). DESIGN Retrospective matched case-case-control study. SETTING Quaternary-care referral NICU at a large academic children's hospital. METHODS Infants admitted between January 2014 and March 2016 at a level IV NICU who acquired methicillin resistant (MRSA) or susceptible (MSSA) S. aureus were matched with controls by duration of exposure to determine risk factors for acquisition. A secondary post hoc analysis was performed on the entire cohort of at-risk infants for risk factors identified in the primary analysis to further quantify risk. RESULTS In total, 1,751 infants were admitted during the study period with 199 infants identified as having S. aureus prevalent on admission. There were 246 incident S. aureus acquisitions in the remaining at-risk infant cohort. On matched analysis, infants housed in a single-bed unit were associated with a significantly decreased risk of both MRSA (P=.03) and MSSA (P=.01) acquisition compared with infants housed in multibed pods. Across the entire cohort, pooled S. aureus acquisition was significantly lower in infants housed in single-bed units (hazard ratio,=0.46; confidence interval, 0.34-0.62). CONCLUSIONS NICU bed design is significantly associated with S. aureus acquisition in hospitalized infants independent of LOS. Infect Control Hosp Epidemiol 2018;39:46-52.
Collapse
|
29
|
Clock SA, Jia H, Patel S, Ferng YH, Alba L, Whittier S, DeLaMora P, Tabibi S, Perlman J, Paul D, Zaoutis T, Larson E, Saiman L. Infant Colonization With Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci Preceding Neonatal Intensive Care Unit Discharge. J Pediatric Infect Dis Soc 2017; 6:e144-e148. [PMID: 28339914 PMCID: PMC5907882 DOI: 10.1093/jpids/pix003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Abstract
Rates of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant enterococci (VRE) were determined for 1320 infants within 7 days of neonatal intensive care unit discharge. Overall, 4% and 1% of the infants were colonized with MRSA or VRE, respectively. Predictors identified in fixed-effects models were surgery during hospitalization (for MRSA colonization) and prolonged antimicrobial treatment (for VRE colonization).
Collapse
Affiliation(s)
| | - Haomiao Jia
- Columbia University School of Nursing, New York;,Department of Biostatistics, Columbia University Mailman School of Public Health, New York
| | | | | | | | | | | | | | - Jeffrey Perlman
- Department of Pediatrics, Weill Cornell Medical College, New York
| | - David Paul
- Christiana Neonatal Associates, Christiana Care Health System, Newark, Delaware
| | - Theoklis Zaoutis
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Lisa Saiman
- Departments of Pediatrics and,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York,Correspondence: L. Saiman, MD, MPH, Department of Pediatrics, 650 West 168th St., PH 4W-470, New York, NY 10032 ()
| |
Collapse
|
30
|
Udo EE, Al-Sweih N. Dominance of community-associated methicillin-resistant Staphylococcus aureus clones in a maternity hospital. PLoS One 2017. [PMID: 28640870 PMCID: PMC5480892 DOI: 10.1371/journal.pone.0179563] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Methicillin- resistant Staphylococcus aureus (MRSA) is a major pathogen causing healthcare- and community- acquired infections. The purpose of this study was to characterize MRSA isolated at the Maternity Hospital between 2006 and 2011 for their genetic relatedness. Materials and methods The MRSA isolates were investigated using a combination of antibiogram, Staphylococcal chromosome cassette mec (SCCmec) and spa typing to determine their relatedness to MRSA isolated in other Kuwait hospitals. The isolates were also investigated for the carriage of genes for Pantone valentine Leukocidin (PVL). Results A total of 103 MRSA obtained from 64 neonates, 17 adult patients and 12 healthcare workers. The isolates were resistant to Kanamycin (46.6%), gentamicin (40.8%), trimethoprim (32%), ciprofloxacin (22.3%), fusidic acid (16.5%), tetracycline (19.4%), erythromycin (15.5%), clindamycin (15.5%), streptomycin (11.6%) high-level mupirocin (2.9%) and chloramphenicol (0.9%). Twenty (19.4%) of the isolates were multiresistant. Thirty-one (30.0%) isolates were positive for PVL. Molecular typing revealed the presence of 11 clonal complexes and 23 clones with ST5-V-t002, (N = 22), ST22-IV-t223 (N = 18), ST22-IV-t852 (N = 10), ST80-IV-t044 (N = 7), ST5-V-t688 (N = 5), ST772-V-t657 (N = 5) and ST239-III-t860 (N = 4) constituting 66.9% of the isolates. Other clones were isolated sporadically. The number of MRSA isolates increased from two in 2006 to 22 in 2011 with a peak of 43 in 2008. Conclusion The study revealed a high prevalence of community-associated MRSA Maternity hospital. The MRSA population consisted of known strains, such as ST239-III-t680, ST22-IV-t223/t852 and ST80-IV-t044, that were reported previously in Kuwait and novel strains such as ST5-V-t002, and several sporadic strains obtained for the first time in the Maternity hospital. This study has provided an initial data which will serve as a platform for future comparative studies on the distribution of MRSA clones in the Maternity hospital in Kuwait.
Collapse
Affiliation(s)
- Edet E. Udo
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- * E-mail:
| | - Noura Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
31
|
Draft Genome Sequence of Methicillin-Resistant Staphylococcus aureus Strain LC33 Isolated from Human Breast Milk. GENOME ANNOUNCEMENTS 2017; 5:5/15/e00154-17. [PMID: 28408673 PMCID: PMC5391411 DOI: 10.1128/genomea.00154-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Here, we report the draft genome sequence of Staphylococcus aureus strain LC33, isolated from human breast milk in Brazil. This microorganism has been typed as ST1/t127/sccmecV. To our knowledge, this is the first draft genome sequence of a methicillin-resistant S. aureus strain isolated from human breast milk.
Collapse
|
32
|
Shirai Y, Arai H, Tamaki K, Konishi H, Kawase Y, Shimizu N, Tateda K, Yoda H. Neonatal methicillin-resistant Staphylococcus aureus colonization and infection. J Neonatal Perinatal Med 2017; 10:439-444. [PMID: 29286935 DOI: 10.3233/npm-16166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is a common etiological agent of a life-threatening infection in neonatal intensive care units (NICUs). Neonates with very low birth weight and patients with serious diseases are more likely to be exposed to invasive procedures which make them at a high risk of MRSA colonization and infection. Since MRSA colonization is a risk factor for MRSA infection, prevention of MRSA transmission is an important issue in NICUs. NICUs in Japan practice standard contact precautions and active surveillance cultures (ASC) to prevent MRSA transmission. In this report, we analyzed the clinical characteristics of MRSA colonization and infection between January 2010 and December 2015 in our perinatal care center. METHODS We conducted retrospective analysis of 1716 neonates hospitalized in our perinatal care center. RESULTS 120 cases had MRSA colonization (6.99%) and among them 33 neonates were infected. The duration of stay (P≤0.001) and the birth weight (P≤0.001) showed statistically significant differences between MRSA-colonized neonates and non-MRSA-colonized neonates. The number of central venous catheterization showed statistically significant differences (P = 0.001) and the number of digestive system diseases showed marginally significant differences (P = 0.072) between MRSA-colonized non-infected neonates and MRSA-infected neonates. CONCLUSIONS As previous reports have shown, we present that the neonates with central venous catheterization were more likely to be infected with MRSA. We also need to pay attention to neonates with digestive system diseases, showing signs of infection, because they may be potentially infected with MRSA.
Collapse
Affiliation(s)
- Yoko Shirai
- Department of Neonatology, Toho University Omori Hospital, Ota-ku, Tokyo, Japan
- Department of Pediatrics, Toho University Ohashi Hospital, Ohashi Meguro-ku, Tokyo, Japan
| | - Hiroko Arai
- Department of Neonatology, Toho University Omori Hospital, Ota-ku, Tokyo, Japan
| | - Kazutomo Tamaki
- Department of Neonatology, Toho University Omori Hospital, Ota-ku, Tokyo, Japan
| | - Hiroe Konishi
- Department of Microbiology and Infectious Diseases, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Pediatrics, Toho University Ohashi Hospital, Ohashi Meguro-ku, Tokyo, Japan
| | - Yasuhiro Kawase
- Department of Neonatology, Toho University Omori Hospital, Ota-ku, Tokyo, Japan
| | - Norikazu Shimizu
- Department of Pediatrics, Toho University Ohashi Hospital, Ohashi Meguro-ku, Tokyo, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Hitoshi Yoda
- Department of Neonatology, Toho University Omori Hospital, Ota-ku, Tokyo, Japan
| |
Collapse
|
33
|
Wisgrill L, Zizka J, Unterasinger L, Rittenschober-Böhm J, Waldhör T, Makristathis A, Berger A. Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible Staphylococcus aureus Infections in VLBW Infants. Neonatology 2017; 112:267-273. [PMID: 28704818 DOI: 10.1159/000477295] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/04/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Methicillin-susceptible Staphylococcus aureus (MSSA) is a major contributor to infectious episodes of very low birth weight infants (VLBWI), resulting in significant morbidity and mortality. OBJECTIVE To examine the efficacy and safety of surveillance cultures and the decolonization of MSSA-colonized VLBWI. METHODS VLBWI admitted to our neonatal wards in 2011-2016 were retrospectively analyzed. Rates of MSSA-attributable infections were compared before and after the implementation of active surveillance cultures and the decolonization of MSSA-colonized patients. The mupirocin susceptibility of isolated MSSA strains was routinely tested. RESULTS A total of 1,056 VLBWI were included in the study, 552 in the pre-intervention period and 504 in the post-intervention period. The implementation of surveillance cultures and decolonization of colonized patients resulted in a 50% reduction of incidence rates per 1,000 patient-days of MSSA-attributable infections (1.63 [95% CI 1.12-2.31] vs. 0.83 [95% CI 0.47-1.35], p = 0.024). No adverse effects were observed from application of the decolonization protocol with mupirocin and octenidin. No mupirocin-resistant MSSA strains were detected during the study period. CONCLUSION Implementation of an active surveillance and decolonization protocol resulted in a reduction of MSSA-attributable infections in VLBWI.
Collapse
Affiliation(s)
- Lukas Wisgrill
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
34
|
Smith SL, Serke L. Case Report of Sepsis in Neonates Fed Expressed Mother's Milk. J Obstet Gynecol Neonatal Nurs 2016; 45:699-705. [DOI: 10.1016/j.jogn.2016.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 12/19/2022] Open
|
35
|
Surveillance and Isolation of Methicillin-Resistant Staphylococcus aureus Colonization in the Neonatal Intensive Care Unit. Adv Neonatal Care 2016; 16:298-307. [PMID: 27391565 DOI: 10.1097/anc.0000000000000312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal sepsis causes 1.4 million (36%) neonatal deaths annually. Staphylococcus aureus (SA), a common skin pathogen, remains the second leading cause of late-onset sepsis in the neonatal intensive care unit (NICU). Methicillin-resistant Staphylococcus aureus (MRSA), a resistant strain of SA, has created a significant global communicable health risk, especially in the NICU. PURPOSE To examine evidence related to NICU infection control practices surrounding MRSA surveillance, identification, and isolation in response to the clinical question, "What strategies should be universally implemented in the NICU to identify and prevent the spread of MRSA?" METHODS/SEARCH STRATEGY Databases were examined for articles on the topical area of MRSA in the neonate. Key terms were used to streamline the search, resulting in 20 primary works and 3 guideline/consensus statements considered imperative in response to the clinical questions. FINDINGS/RESULTS Hand hygiene remains the cornerstone to sound infection control practice. Colonization often leads to systemic infection, with smaller neonates at greatest risk. Hospital infection control compliance has improved outcomes. MRSA surveillance has reduced horizontal spread. No universal, specific recommendations exist to guide surveillance and management of MRSA in the NICU. IMPLICATIONS FOR PRACTICE Standardized guidelines with procedures for hand hygiene, patient surveillance and isolation, and patient cohorting with recommended staffing patterns should guide practice in the NICU. Both MRSA culture and polymerase chain reaction effectively identify positive patients. Decolonization practices are not yet clear. IMPLICATIONS FOR RESEARCH Evaluation of standard isolation practices versus outbreak response and approaches to neonatal decolonization should be evaluated for efficacy, safety, and resistance.
Collapse
|
36
|
Active Surveillance Cultures and Decolonization to Reduce Staphylococcus aureus Infections in the Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2016; 37:381-7. [PMID: 26725699 DOI: 10.1017/ice.2015.316] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Staphylococcus aureus is a common cause of healthcare-associated infections in neonates. OBJECTIVE To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. METHODS We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models. RESULTS Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected. CONCLUSION Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
Collapse
|
37
|
Koh JW, Song IG, Kim SY, Jung YH, Shin SH, Kim EK, Kim HS, Choi JH, Lee JY. Decolonization of Methicillin resistant Staphylococcus aureus: Role in the Neonatal Intensive Care Unit. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.2.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Ji Won Koh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - In Gyu Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Yun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Young Lee
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
38
|
Horner K, Yamada M, Zuccoli G, Rosenberg S, Greene S, Vellody K, Zuckerbraun NS. A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, and Staphylococcus aureus Bacteremia. Pediatrics 2016; 137:peds.2015-1406. [PMID: 26644490 DOI: 10.1542/peds.2015-1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/24/2022] Open
Abstract
A 34-day-old previously healthy boy born full term presented to the emergency department with fever at home (38.1°C), fussiness, and decreased oral intake for 1 day. He was difficult to console at home. He had decreased oral intake without emesis, diarrhea, or a change in urine output. He did not have rhinorrhea, cough, or increased work of breathing noted by parents. He lived at home with his parents and 13-year-old brother, did not attend day care, and had no sick contacts. On examination, he was fussy but consolable. He was febrile to 39.3°C, tachycardic (180 beats per minute), and tachypneic (64 breaths per minute), with mottling and a capillary refill of 3 seconds. The remainder of his examination was normal, without an infectious focus for his fever. A complete blood cell count with differential revealed leukocytosis. A basic metabolic panel was normal. A catheter urinalysis was normal. Cerebrospinal fluid examination yielded pleocytosis, low glucose, and elevated protein. Blood cultures were persistently positive with methicillin-sensitive Staphylococcus aureus, but cerebrospinal fluid cultures remained negative. We present his case, management, and ultimate diagnosis.
Collapse
Affiliation(s)
| | | | | | | | - Stephanie Greene
- Neurosurgery, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
39
|
Ericson JE, Popoola VO, Smith PB, Benjamin DK, Fowler VG, Benjamin DK, Clark RH, Milstone AM. Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants. JAMA Pediatr 2015; 169:1105-11. [PMID: 26502073 PMCID: PMC4694042 DOI: 10.1001/jamapediatrics.2015.2380] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Staphylococcus aureus is a frequent cause of infection in hospitalized infants. These infections are associated with increased mortality and morbidity and longer hospital stays, but data on the burden of S aureus disease in hospitalized infants are limited. OBJECTIVES To compare demographics and mortality of infants with invasive methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA), to determine the annual proportion of S aureus infections that were MRSA, and to contrast the risk of death after an invasive MRSA infection with the risk after an invasive MSSA infection. DESIGN, SETTING, AND PARTICIPANTS Multicenter retrospective study of a large, nationally representative cohort at 348 neonatal intensive care units managed by the Pediatrix Medical Group. Participants were 3888 infants with an invasive S aureus infection who were discharged from calendar year 1997 through calendar year 2012. EXPOSURE Invasive S aureus infection. MAIN OUTCOMES AND MEASURES The incidence of invasive S aureus infections, as well as infant characteristics and mortality after MRSA or MSSA infection. RESULTS The 3888 infants had 3978 invasive S aureus infections (2868 MSSA and 1110 MRSA). The incidence of invasive S aureus infection was 44.8 infections per 10,000 infants. The yearly proportion of invasive infections caused by MRSA increased from calendar year 1997 through calendar year 2006 and has moderately decreased since then. Infants with invasive MRSA or MSSA infections had similar gestational ages and birth weights. Invasive MRSA infections occurred more often at a younger postnatal age. For infants with available mortality data, more infants with invasive MSSA infections (n = 237) died before hospital discharge than infants with invasive MRSA infections (n = 110). The proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2474 (9.6%) and 110 of 926 (11.9%), respectively (P = .05). The adjusted risk of death before hospital discharge was similar after invasive MSSA and MRSA infections (risk ratio, 1.19; 95% CI, 0.96-1.49). The risks of death at 7 and 30 days after invasive infection were similar between infants with invasive MSSA infection and infants with invasive MRSA infection. CONCLUSIONS AND RELEVANCE Infant mortality after invasive MRSA and MSSA infections is similar, but MSSA causes more infections and more deaths in infants than MRSA. Measures to prevent S aureus infection should include MSSA in addition to MRSA.
Collapse
Affiliation(s)
- Jessica E. Ericson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Victor O. Popoola
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - Vance G. Fowler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - Aaron M. Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
40
|
Thaden JT, Ericson JE, Cross H, Bergin SP, Messina JA, Fowler VG, Benjamin DK, Clark RH, Hornik CP, Smith PB. Survival Benefit of Empirical Therapy for Staphylococcus aureus Bloodstream Infections in Infants. Pediatr Infect Dis J 2015; 34:1175-9. [PMID: 26222060 PMCID: PMC4604046 DOI: 10.1097/inf.0000000000000850] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of early adequate empirical antibiotic therapy on outcomes of infants in the neonatal intensive care unit (NICU) who develop Staphylococcus aureus bloodstream infections (BSI) is unknown. METHODS Infants with S. aureus BSI discharged in 1997-2012 from 348 NICUs managed by the Pediatrix Medical Group were identified. Early adequate empirical antibiotic therapy was defined as exposure to ≥1 antibiotic with anti-staphylococcal activity on the day the first positive blood culture was obtained. All other cases were defined as inadequate empirical antibiotic therapy. We evaluated the association between inadequate empirical antibiotic therapy on outcomes controlling for gestational age, small for gestational age status, gender, discharge year, mechanical ventilation, inotropic support and use of supplemental oxygen. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, death before hospital discharge and length of bacteremia. RESULTS Of the 3339 infants with S. aureus BSI, 2492 (75%) had methicillin-susceptible S. aureus (MSSA) BSI and 847 (25%) had methicillin-resistant S. aureus (MRSA) BSI. Inadequate empirical antibiotic therapy was administered in 725 (22%) cases. Inadequate empirical antibiotic therapy was associated with increased 30-day mortality (odds ratio: 2.03; 95% confidence interval: 1.08-3.82) among infants with MRSA BSI. Inadequate empirical antibiotic therapy was not associated with increases in mortality among infants with MSSA BSI. CONCLUSIONS After controlling for confounders, inadequate empirical antibiotic therapy was associated with a modestly increased mortality at 30 days for infants with MRSA BSI.
Collapse
Affiliation(s)
- Joshua T. Thaden
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Jessica E. Ericson
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Heather Cross
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Stephen P. Bergin
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Julia A. Messina
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Vance G. Fowler
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Christoph P. Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - P. Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| |
Collapse
|
41
|
Layer F, Sanchini A, Strommenger B, Cuny C, Breier AC, Proquitté H, Bührer C, Schenkel K, Bätzing-Feigenbaum J, Greutelaers B, Nübel U, Gastmeier P, Eckmanns T, Werner G. Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit. Int J Med Microbiol 2015; 305:790-8. [PMID: 26321006 DOI: 10.1016/j.ijmm.2015.08.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected.
Collapse
Affiliation(s)
- Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.
| | - Andrea Sanchini
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Christiane Cuny
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Ann-Christin Breier
- Institute of Hygiene and Environmental Medicine, Charité University Medical Centre, Berlin, Germany
| | - Hans Proquitté
- Department of Neonatology, Charité University Medical Centre, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Centre, Berlin, Germany
| | - Karl Schenkel
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Department of Infectious Disease Prevention and Control, Community Health Office City of Berlin Mitte, Berlin, Germany
| | - Jörg Bätzing-Feigenbaum
- Department of Infectious Disease Epidemiology and Environmental Health Protection, State Office for Health and Social Affairs, Federal State of Berlin, Berlin, Germany
| | - Benedikt Greutelaers
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ulrich Nübel
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité University Medical Centre, Berlin, Germany
| | - Tim Eckmanns
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| |
Collapse
|
42
|
Epidemiology of Methicillin-Susceptible Staphylococcus aureus in a Neonatology Ward. Infect Control Hosp Epidemiol 2015; 36:1305-12. [PMID: 26290400 DOI: 10.1017/ice.2015.184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward. DESIGN Multimodal outbreak investigation SETTING A public 800-bed tertiary care university hospital in Switzerland METHODS Investigations in 2012-2013, triggered by a MSSA infection cluster, included prospective MSSA infection surveillance, microbiologic screening of neonates and environment, onsite observations, and a prospective cohort study. MSSA isolates were characterized by pulsed-field gel electrophoresis (PFGE) and selected isolates were examined for multilocus sequence type (MLST) and virulence factors. RESULTS Among 726 in 2012, 30 (4.1%) patients suffered from MSSA infections including 8 (1.1%) with bacteremia. Among 655 admissions in 2013, 13 (2.0%) suffered from MSSA infections including 2 (0.3%) with bacteremia. Among 177 neonates screened for S. aureus carriage, overall 77 (44%) tested positive. A predominant PFGE-1-ST30 strain was identified in 6 of 30 infected neonates (20%) and 30 of 77 colonized neonates (39%). This persistent clone was pvl-negative, tst-positive and belonged to agr group III. We found no environmental point source. MSSA carriage was associated with central vascular catheter use but not with a particular midwife, nurse, physician, or isolette. Observed healthcare worker behavior may have propagated transmission via hands and fomites. Despite multimodal interventions, clonal transmission and colonization continued and another clone, PFGE-6-ST5, became predominant. CONCLUSIONS Hospital-acquired MSSA clones represent a high proportion of MSSA colonization but not MSSA infections in neonate inpatients. In contrast to persisting MSSA, transmission infection rates decreased concurrently with interventions. It remains to be established whether eradication of hospital-acquired MSSA strains would reduce infection rates further.
Collapse
|
43
|
Blanchard AC, Quach C, Autmizguine J. Staphylococcal infections in infants: updates and current challenges. Clin Perinatol 2015; 42:119-32, ix. [PMID: 25678000 DOI: 10.1016/j.clp.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Staphylococci are common pathogens in the neonatal period. Increased survival of premature infants leads to prolonged hospital stay with associated risk factors for developing invasive staphylococcal disease. Challenges of diagnosing coagulase-negative staphylococcal infections result in conflicting definitions and inconsistent clinical practice. Resistance to methicillin influences the choice of empirical therapy.
Collapse
Affiliation(s)
- Ana C Blanchard
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Caroline Quach
- Division of Infectious Diseases, Department of Medical Microbiology, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Julie Autmizguine
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec H3T 1J4, Canada; Research Center CHU Sainte-Justine, 3175 Chemin Côte Sainte Catherine, Montreal, Quebec H3T 1C5, Canada.
| |
Collapse
|
44
|
Kraus-Haas M, Mielke M, Simon A. [Update on outbreaks reported from neonatal intensive care units (2010-203): Staphylococcus aureus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:323-38. [PMID: 25566845 DOI: 10.1007/s00103-014-2115-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In terms of the unique risk profile of the patients and the morbidity associated with S. aureus infections in this vulnerable patient population, the literature on outbreaks of S. aureus (including MRSA) in neonatal intensive care units (NICUs) needs to be analyzed separately from reports derived from other intensive care units. With the objective of updating important information for those involved in outbreak management and fostering preventive efforts, this article summarizes the results of a systematic literature analysis, referring to an earlier publication by Gastmeier et al. It focuses on NICU outbreaks caused by S. aureus (including MRSA) and on controlling them.
Collapse
|
45
|
Engelman D, Hofer A, Davis JS, Carapetis JR, Baird RW, Giffard PM, Holt DC, Tong SYC. Invasive Staphylococcus aureus Infections in Children in Tropical Northern Australia. J Pediatric Infect Dis Soc 2014; 3:304-11. [PMID: 26625450 DOI: 10.1093/jpids/piu013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/20/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children. METHODS We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007-2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days). RESULTS Forty-four cases (9 neonatal, 35 pediatric) were identified. The annual incidence of ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95% confidence interval, 3.8-41.4]). Pediatric infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34% resulted in intensive care admission. Neonatal cases were all born prematurely; 89% were late-onset infections. Overall, 27% of infections were due to methicillin-resistant S aureus (MRSA). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA cases were readmitted. CONCLUSIONS The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA.
Collapse
Affiliation(s)
- Daniel Engelman
- Royal Darwin Hospital, Darwin, Australia; Centre for International Child Health, University of Melbourne, Australia
| | | | - Joshua S Davis
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - Jonathan R Carapetis
- Menzies School of Health Research, Darwin, Australia; Telethon Institute for Child Health Research, University of Western Australia, Perth
| | | | | | | | - Steven Y C Tong
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| |
Collapse
|
46
|
Affiliation(s)
- A J Carey
- 1] Division of Neonatology, Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA, USA [2] Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| |
Collapse
|
47
|
Hocevar SN, Lessa FC, Gallagher L, Conover C, Gorwitz R, Iwamoto M. Infection prevention practices in neonatal intensive care units reporting to the national healthcare safety network. Infect Control Hosp Epidemiol 2014; 35:1126-32. [PMID: 25111920 DOI: 10.1086/677636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients in the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections. Variability in reported infection rates among NICUs exists, possibly related to differences in prevention strategies. A better understanding of current prevention practices may help identify prevention gaps and areas for further research. METHODS We surveyed infection control staff in NICUs reporting to the National Healthcare Safety Network (NHSN) to assess strategies used to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and central line-associated bloodstream infections in NICUs. RESULTS Staff from 162 of 342 NICUs responded (response rate, 47.3%). Most (92.3%) NICUs use central line insertion and maintenance bundles, but maintenance practices varied, including agents used for antisepsis and frequency of dressing changes. Forty-two percent reported routine screening for MRSA colonization upon admission for all patients. Chlorhexidine gluconate (CHG) use for central line care for at least 1 indication (central line insertion, dressing changes, or port/cap antisepsis) was reported in 82 NICUs (51.3%). Among sixty-five NICUs responding to questions on CHG use restrictions, 46.2% reported no restrictions. CONCLUSIONS Our survey illustrated heterogeneity of CLABSI and MRSA prevention practices and underscores the need for further research to define optimal strategies and evidence-based prevention recommendations for neonates.
Collapse
Affiliation(s)
- Susan N Hocevar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | |
Collapse
|
48
|
Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009. BMC Pediatr 2014; 14:121. [PMID: 24886471 PMCID: PMC4024190 DOI: 10.1186/1471-2431-14-121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Invasive methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections are major causes of numerous neonatal intensive care unit (NICU) outbreaks. There have been increasing reports of MRSA outbreaks in various neonatal intensive care units (NICUs) over the last decade. Our objective was to review the experience of Staphylococcus aureus sepsis in our NICU in the last decade and describe the trends in the incidence of Staphylococcus aureus blood stream infections from 2000 to 2009. METHODS A retrospective perinatal database review of all neonates admitted to our NICU with blood cultures positive for Staphylococcus aureus from (Jan 1st 2000 to December 31st 2009) was conducted. Infants were identified from the database and data were collected regarding their clinical characteristics and co-morbidities, including shock with sepsis and mortality. Period A represents patients admitted in 2000-2003. Period B represents patients seen in 2004-2009. RESULTS During the study period, 156/11111 infants were identified with Staphylococcus aureus blood stream infection: 41/4486 (0.91%) infants in Period A and 115/6625 (1.73%) in Period B (p < 0.0004). Mean gestation at birth was 26 weeks for infants in both periods. There were more MRSA infections in Period B (24% vs. 55% p < 0.05) and they were associated with more severe outcomes. In comparing the cases of MRSA infections observed in the two periods, infants in period B notably had significantly more pneumonia cases (2.4% vs. 27%, p = 0.0005) and a significantly higher mortality rate (0% vs. 15.7%, p = 0.0038). The incidences of skin and soft tissue infections and of necrotizing enterocolitis were not significantly changed in the two periods. CONCLUSION There was an increase in the incidence of Staphylococcus aureus infection among neonates after 2004. Although MSSA continues to be a problem in the NICU, MRSA infections were more prevalent in the past 6 years in our NICU. Increased severity of staphylococcal infections and associated rising mortality are possibly related to the increasing MRSA infections with a more virulent community-associated strain.
Collapse
|
49
|
Geraci DM, Giuffrè M, Bonura C, Matranga D, Aleo A, Saporito L, Corsello G, Larsen AR, Mammina C. Methicillin-resistant Staphylococcus aureus colonization: a three-year prospective study in a neonatal intensive care unit in Italy. PLoS One 2014; 9:e87760. [PMID: 24505312 PMCID: PMC3914835 DOI: 10.1371/journal.pone.0087760] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Methicillin resistant Staphylococcus aureus (MRSA) is a major etiological agent of infection in neonatal intensive care units (NICUs). Routes of entry of this organism can be different and the transmission pathway complex. Colonized neonates are the main endogenous reservoir. METHODS AND RESULTS We conducted a prospective three-year study on MRSA colonization recruiting 722 neonates admitted between 2009 and 2012. Nasal swabs were cultured weekly and MRSA isolates were submitted to molecular typing. The annual incidence density of acquisition of MRSA ranged from a maximum of 20.2 cases for 1000 patient-days during the first year to a minimum of 8.8 cases in the second one to raise again up to 13.1 cases during the third year. The mean weekly colonization pressure fluctuated from 19.1% in the first year to 13.4% in the second year and 16.8% in the third year. It significantly correlated with the number of MRSA acquisitions in the following week. Overall, 187 (25.9%) subjects tested positive for MRSA. A non multiresistant, tst positive, ST22-MRSA-IVa spa t223 strain proved to be endemic in the NICU, being identified in 166 (88.8%) out of 187 colonized neonates. Sporadic or epidemic occurrence of other strains was detected. CONCLUSIONS An MRSA strain belonging to the tst1 positive, UK-EMRSA-15/ "Middle Eastern Variant" appeared to be endemic in the NICU under investigation. During the three-year period, substantial changes occurred in case-mix of patients moving towards a higher susceptibility to MRSA colonization. The infection control procedures were able to decrease the colonization rate from more than 40% to approximately 10%, except for an outbreak due to a CA-MRSA strain, ST1-MRSA-IVa, and a transient increase in the colonization prevalence rate coincident with a period of substantial overcrowding of the ward. Active surveillance and molecular typing contributed to obtain a reliable picture of the MRSA dissemination in NICU.
Collapse
Affiliation(s)
- Daniela M. Geraci
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
- PhD School in Food and Human Nutrition, University of Palermo, Palermo, Italy
| | - Mario Giuffrè
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Celestino Bonura
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Domenica Matranga
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Aurora Aleo
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Laura Saporito
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Postgraduate Specialty School of Hygiene and Preventive Medicine, University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | | | - Caterina Mammina
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
- * E-mail:
| |
Collapse
|
50
|
Methicillin-Resistant Staphylococcus aureus and the Eye: Current Concepts and Management Strategies. CURRENT OPHTHALMOLOGY REPORTS 2013. [DOI: 10.1007/s40135-013-0030-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|