Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-12-01T01:54:52.072Z Has data issue: false hasContentIssue false
  • English
  • Français

Changes in the Molecular Epidemiological Characteristics of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Alison J. Carey ,
Phyllis Della-Latta ,
Richard Huard ,
Fann Wu ,
Phillip L. Graham III ,
Diane Carp  and
Lisa Saiman
Alison J. Carey*
Affiliation:
Department of Pediatrics, Division of Neonatology, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
Phyllis Della-Latta
Affiliation:
Department of Pathology, New York-Presbyterian Hospital, New York, New York Clinical Microbiology Service, New York-Presbyterian Hospital, New York, New York
Richard Huard
Affiliation:
Department of Pathology, New York-Presbyterian Hospital, New York, New York Clinical Microbiology Service, New York-Presbyterian Hospital, New York, New York
Fann Wu
Affiliation:
Department of Pathology, New York-Presbyterian Hospital, New York, New York Clinical Microbiology Service, New York-Presbyterian Hospital, New York, New York
Phillip L. Graham III
Affiliation:
Morgan Stanley Children's Hospital of New York-Presbyterian, New York-Presbyterian Hospital, New York, New York Department of Pediatrics, Division of Infectious Diseases, New York-Presbyterian Hospital, New York, New York Columbia University, and the Department of Infection Control and Prevention, New York-Presbyterian Hospital, New York, New York
Diane Carp
Affiliation:
Columbia University, and the Department of Infection Control and Prevention, New York-Presbyterian Hospital, New York, New York
Lisa Saiman
Affiliation:
Morgan Stanley Children's Hospital of New York-Presbyterian, New York-Presbyterian Hospital, New York, New York Department of Pediatrics, Division of Infectious Diseases, New York-Presbyterian Hospital, New York, New York Columbia University, and the Department of Infection Control and Prevention, New York-Presbyterian Hospital, New York, New York
*
Division of Neonatology, St. Christopher's Hospital for Children, 3601 A Street, Philadelphia, PA 19134, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

To determine whether the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus (MRSA) had changed in a level III neonatal intensive care unit (NICU).

Design.

Retrospective review of medical records.

Setting.

Level III NICU of a university-affiliated children's hospital in New York, New York.

Patients.

Case patients were neonates hospitalized in the NICU who were colonized or infected with MRSA.

Methods.

Rates of colonization and infection with MRSA during the period from 2000 through 2008 were assessed. Staphylococcal chromosomal cassette (SCC) mecA analysis and genotyping for S. aureus encoding protein A (spa) were performed on representative MRSA isolates from each clonal pulsed-field gel electrophoresis pattern.

Results.

Endemic MRSA infection and colonization occurred throughout the study period, which was punctuated by 4 epidemiologic investigations during outbreak periods. During the study period, 93 neonates were infected and 167 were colonized with MRSA. Surveillance cultures were performed for 1,336 neonates during outbreak investigations, and 115 (8.6%) neonates had MRSA-positive culture results. During 2001-2004, healthcare-associated MRSA clones, carrying SCC mec type II, predominated. From 2005 on, most MRSA clones were community-associated MRSA with SCC mec type IV, and in 2007, USA300 emerged as the principal clone.

Conclusions.

Molecular analysis demonstrated a shift from healthcare-associated MRSA (2001-2004) to community-associated MRSA (2005-2008).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 613 - 619
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

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

References

1.Banerjee, SN, Grohskopf, LA, Sinkowitz-Cochran, RL, Jarvis, WR. Incidence of pediatric and neonatal intensive care unit-acquired infections. Infect Control Hosp Epidemiol 2006;27:561–570.Google Scholar
2.Baltimore, RS. Neonatal nosocomial infections. Semin Perinatol 1998;22: 25–32.CrossRefGoogle ScholarPubMed
3.Stoll, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.CrossRefGoogle ScholarPubMed
4.Seybold, U, Halvosa, JS, White, N, Voris, V, Ray, SM, Blumberg, HM. Emergence of and risk factors for methicillin-resistant Staphylococcus aureus of community origin in intensive care nurseries. Pediatrics 2008; 122: 1039–1046.CrossRefGoogle ScholarPubMed
5.McAdams, RM, Ellis, MW, Trevino, S, Rajnik, M. Spread of methicillin-resistant Staphylococcus aureus USA300 in a neonatal intensive care unit. Pediatr Int 2008;50:810–815.Google Scholar
6.Bertin, ML, Vinski, J, Schmitt, S, et al.Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 2006;27:581–585.CrossRefGoogle Scholar
7.Saiman, L, Cronquist, A, Wu, F, et al.An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317–321.Google Scholar
8.Carey, AJ, Duchon, J, Delia-Latta, P, Saiman, L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000-2007. J Perinatol 2010;30:135–139.CrossRefGoogle Scholar
9.Gonzalez, BE, Martinez-Aguilar, G, Hulten, KG, et al.Severe staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatrics 2005;115:642–648.CrossRefGoogle ScholarPubMed
10.Miller, LG, Perdreau-Remington, F, Rieg, G, et al.Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352:1445–1453.CrossRefGoogle ScholarPubMed
11.Chen, KT, Huard, RC, Delia-Latta, P, Saiman, L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006;108:482–487.Google Scholar
12.Andrews, WW, Schelonka, R, Waites, K, Stamm, A, Cliver, SP, Moser, S. Genital tract methicillin-resistant Staphylococcus aureus: risk of vertical transmission in pregnant women. Obstet Gynecol 2008;111:113–118.Google Scholar
13.Saiman, L, O'Keefe, M, Graham, PL III, et al.Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003;37:1313–1319.CrossRefGoogle ScholarPubMed
14.Roberts, RB, de Lencastre, A, Eisner, W, et al.Molecular epidemiology of methicillin-resistant Staphylococcus aureus in 12 New York hospitals. J Infect Dis 1998;178:164–171.Google Scholar
15.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
16.Koreen, L, Ramaswamy, SV, Graviss, EA, Naidich, S, Musser, JM, Kreiswirth, BN. spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro-and macrovariation. J Clin Microbiol 2004;42:792–799.CrossRefGoogle ScholarPubMed
17.Lina, G, Piemont, Y, Godail-Gamot, F, et al.Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128–1132.CrossRefGoogle ScholarPubMed
18.McDonald, RR, Antonishyn, NA, Hansen, T, et al.Development of a triplex real-time PCR assay for detection of Panton-Valentine leukocidin toxin genes in clinical isolates of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:6147–6149.CrossRefGoogle ScholarPubMed
19.Zhang, K, McClure, JA, Elsayed, S, Louie, T, Conly, JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:5026–5033.Google Scholar
20.Oliveira, DC, de Lencastre, H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimtcrob Agents Chemother 2002; 46:2155–2161.CrossRefGoogle ScholarPubMed
21.Haas, J, Larson, E, Ross, B, See, B, Saiman, L. Epidemiology and diagnosis of hospital-acquired conjunctivitis among neonatal intensive care unit patients. Pediatr Infect Dis J 2005;24:586–589.Google Scholar
22.Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests-approved standard. 10th ed. CLSI document M2-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.Google Scholar
23.Clinical and Laboratory Standards Institute (CLSI). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically-approved standard. 8th ed. CLSI document M7-A8. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.Google Scholar
24.Healy, CM, Hulten, KG, Palazzi, DL, Campbell, JR, Baker, CJ. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004;39:1460–1466.CrossRefGoogle Scholar
25.David, MD, Kearns, AM, Gossain, S, Ganner, M, Holmes, A. Community-associated methicillin-resistant Staphylococcus aureus: nosocomial transmission in a neonatal unit. J Hosp Infect 2006;64:244–250.CrossRefGoogle Scholar
26.Gastelum, DT, Dassey, D, Mascola, L, Yasuda, LM. Transmission of community-associated methicillin-resistant Staphylococcus aureus from breast milk in the neonatal intensive care unit. Pediatr Infect Dis J 2005; 24:1122–1124.CrossRefGoogle ScholarPubMed
27.Al-Tawfiq, JA. Father-to-infant transmission of community-acquired methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2006;27:636–637.Google Scholar
28.Watson, J, Jones, RC, Cortes, C, et al.Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns-Chicago and Los Angeles County, 2004. MMWR Morb Mortal Wkly Rep 2006;55:329–332.Google Scholar
29.Fortunov, RM, Hulten, KG, Hammerman, WA, Mason, EO Jr, Kaplan, SL. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006;118:874–881.CrossRefGoogle ScholarPubMed
30.Cannon, JGA, Perlman, J, DeLaMora, P, et al.Transmission of USA-300 methicillin-resistant Staphylococcus aureus in a newborn nursery also affecting post-partum women. In: Abstracts of the 18th Annual Meeting of the Society for Healthcare Epidemiology of America. Arlington, VA: Society for Healthcare Epidemiology of America; 2008. Abstract 178.Google Scholar
31.Bratu, S, Eramo, A, Kopec, R, et al.Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis 2005;11:808–813.CrossRefGoogle ScholarPubMed
32.Gerber, SI, Jones, RC, Scott, MV, et al.Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006;27:139–145.CrossRefGoogle ScholarPubMed
33.Lepelletier, D, Corvee, S, Caillon, J, Reynaud, A, Roze, JC, Gras-Leguen, C. Eradication of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: which measures for which success? Am J Infect Control 2009;37:195–200.Google Scholar
34.Stein, M, Navon-Venezia, S, Chmelnitsky, I, et al.An outbreak of new, nonmultidrug-resistant, methicillin-resistant Staphylococcus aureus strain (SCCmec type IIIA variant-1) in the neonatal intensive care unit transmitted by a staff member. Pediatr Infect Dis J 2006;25:557–559.Google Scholar
35.Grant, PS, Charns, LG, Rawot, BW, Benedetti, SG. Consideration to culture health care workers related to increased methicillin-resistant Staphylococcus aureus activity in a neonatal intensive care unit. Am J Infect Control 2008;36:638–643.CrossRefGoogle Scholar
36.Calfee, DP, Saigado, CD, Classen, D, et al.Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S62–S80.Google Scholar
37.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10suppl 2):S165–S193.CrossRefGoogle ScholarPubMed
38.Huang, YC, Chou, YH, Su, LH, Lien, RI, Lin, TY. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics 2006;118:469–474.Google Scholar
39.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36: 281–285.Google Scholar
40.Schultz, ED, Tanaka, DT, Goldberg, RN, Benjamin, DK Jr, Smith, PB. Effect of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit on total hospital cost. Infect Control Hosp Epidemiol 2009;30:383–385.CrossRefGoogle ScholarPubMed