Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T20:06:37.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Eradication of Methicillin-Resistant Staphylococcus Aureus From a Neonatal Intensive Care Unit by Active Surveillance and Aggressive Infection Control Measures

Published online by Cambridge University Press:  21 June 2016

Jad Khoury ,
Marilyn Jones ,
Autumn Grim ,
Wm. Michael Dunne Jr  and
Vicky Fraser
Jad Khoury
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marilyn Jones
Affiliation:
BJC Infection Control and Healthcare Epidemiology Consortium, Washington University School of Medicine, St. Louis, Missouri
Autumn Grim
Affiliation:
BJC Infection Control and Healthcare Epidemiology Consortium, Washington University School of Medicine, St. Louis, Missouri
Wm. Michael Dunne Jr
Affiliation:
Department of Microbiology, Washington University School of Medicine, St. Louis, Missouri
Vicky Fraser*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Infectious Diseases Division, Washington University School of Medicine, Box 8051, 660 S. Euclid Ave., St. Louis, MO 63110.[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it.

Setting:

An 18-bed, level III-IV NICU in a community hospital.

Methods:

Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and decolonization of infants and HCWs with MRSA. A case–control study was performed to compare infants with and without MRSA.

Results:

A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9–363.1) and infection (OR, 5.36; CI95, 1.37–20.96). Gavage feeding (OR, 10.33; CI95, 1.28–83.37) and intubation (OR, 5.97; CI95, 1.22–29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA.

Conclusion:

Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2½ years following the outbreak. (Infect Control Hosp Epidemiol 2005;26:616-621)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 7 , July 2005 , pp. 616 - 621
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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.Back, NA, Linnemann, CC Jr, Staneck, JL, Kotagal, UR. Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: use of intensive microbiologic surveillance and mupirocin. Infect Control Hosp Epidemiol 1996;17:227–231.Google Scholar
2.Haley, RW, Cushion, NB, Tenover, FC, et al.Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.CrossRefGoogle ScholarPubMed
3.Farrington, M, Ling, J, Ling, T, French, GL. Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burn units of a new hospital. Epidemiol Infect 1990;105:215–228.CrossRefGoogle ScholarPubMed
4.Haddad, Q, Sobayo, EI, Basit, OB, Rotimi, VO. Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Hosp Infect 1993;23:211–222.CrossRefGoogle Scholar
5.Andersen, BM, Lindemann, R, Bergh, K, et al.Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 2002;50:18–24.CrossRefGoogle Scholar
6.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM.Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:126–132.CrossRefGoogle ScholarPubMed
7.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, ed. 4. Villanova, PA: National Committee for Clinical Laboratory Standards; 1990. Approved standard M2-A4.Google Scholar
8.Del Vecchio, VG, Petroziello, JM, Gress, MJ, et al.Molecular genotyping of methicillin-resistant Staphylococcus aureus via fluorophore-en-hanced repetitive-sequence PCR. J Clin Microbiol 1995;33:2141–2144.CrossRefGoogle ScholarPubMed
9.Kang, HP, Dunne, WM. Stability of repetitive-sequence PCR patterns with respect to culture age and subculture frequency. J Clin Microbiol 2003;41:2694–2696.CrossRefGoogle ScholarPubMed
10.Francois, P, Renzi, G, Pittet, D, et al.A novel multiplex real-time PCR for rapid typing of major staphylococcal cassette chromosome mec elements. J Clin Microbiol 2004;42:3309–3312.CrossRefGoogle ScholarPubMed
11.Jarraud, S, Mougel, C, Thioulouse, J, et al.Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles) and human disease. Infect Immun 2002;70:631–641.CrossRefGoogle ScholarPubMed
12.Saiman, L, Cronquist, A, Wu, F, et al.An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317–321.CrossRefGoogle Scholar
13.Noel, GJ, Kreiswirth, BN, Edelson, PJ, et al.Multiple methicillin-resistant Staphylococcus aureus strains as a cause for a single outbreak of severe disease in hospitalized neonates. Pediatr Infect Dis J 1992;11:184–188.CrossRefGoogle ScholarPubMed
14.Boyce, JM, Jackson, MM, Pugliese, G, et al.Methicillin-resistant Staphylococcus aureus: a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–115.CrossRefGoogle ScholarPubMed
15.van der Zee, A, Verbakel, H, van Zon, J-C, et al.Molecular genotyping of Staphylococcus aureus strains: comparison of repetitive element sequence-based PCR with various typing methods and isolation of a novel epidemicity marker. J Clin Microbiol 1999;37:342–349.CrossRefGoogle ScholarPubMed
16.Quelle, LS, Corso, A, Galas, M, Sordelli, DO. STAR gene restriction profile analysis in epidemiological typing of methicillin-resistant Staphylococcus aureus: description of the new method and comparison with other polymerase chain reaction (PCR)-based methods. Diag Microbiol Infect Dis 2003;47:455–464.CrossRefGoogle ScholarPubMed
17.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