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Methicillin-Resistant Staphylococcus aureus Transmission and Infections in a Neonatal Intensive Care Unit despite Active Surveillance Cultures and Decolonization: Challenges for Infection Prevention

Published online by Cambridge University Press:  10 May 2016

Victor O. Popoola ,
Alicia Budd ,
Sara M. Wittig ,
Tracy Ross ,
Susan W. Aucott ,
Trish M. Perl ,
Karen C. Carroll  and
Aaron M. Milstone
Victor O. Popoola
Affiliation:
Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Alicia Budd
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Sara M. Wittig
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Tracy Ross
Affiliation:
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Susan W. Aucott
Affiliation:
Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Trish M. Perl
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Aaron M. Milstone*
Affiliation:
Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
*
200 North Wolfe Street, Rubenstein 3141, Baltimore, MD 21287 (amilstol@jhmi.edu)
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Abstract

Objective.

To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control.

Setting and Design.

Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home.

Methods.

Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and an MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE).

Results.

Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for 21 days or more became recolonized with MRSA. Using PFGE, there were 14 different strain types identified, with USA300 being the most common (31%).

Conclusions.

Current strategies to prevent infections—including active identification and decolonization of MRSA-colonized neonates—are inadequate because infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 412 - 418
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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