Methicillin-Resistant Staphylococcus aureus Transmission and Infections in a Neonatal Intensive Care Unit despite Active Surveillance Cultures and Decolonization: Challenges for Infection Prevention
Methicillin-Resistant Staphylococcus aureus Transmission and Infections in a Neonatal Intensive Care Unit despite Active Surveillance Cultures and Decolonization: Challenges for Infection Prevention
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DOI：
10.1086/675594
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发表时间：
2014-04-01
影响因子：
4.5
通讯作者：
Milstone, Aaron M.
中科院分区：
文献类型：
--
作者：
Popoola, Victor O.;Budd, Alicia;Milstone, Aaron M.
目的：描述IIIC级新生儿重症监护病房（NICU）中耐甲氧西林金黄色葡萄球菌（MRSA）传播和感染的流行病学特征，并确定MRSA控制的障碍。附属NICU的MRSA控制计划，包括所有新生儿的每周鼻孔培养和从其他医院转移或入院的新生儿的入院鼻孔培养。方法：回顾2007年4月至2011年12月期间新生儿重症监护室获得性MRSA定植或感染的病历。监测手部卫生和MRSA非殖民化方案的依从性。结果：在3,536例新生儿中，74例（2.0%）培养出MRSA，其中62例新生儿为NICU获得性MRSA。74名新生儿中有19名（26%）患有MRSA感染，其中8名在被确定为MRSA定植之前就已感染，66名定植新生儿中有11名（17%）随后发生感染。在37例接受去殖民化的新生儿中，6例（16%）发生了后续感染，14例（50%）留在NICU 21天或更长时间的新生儿中有7例（50%）发生了MRSA感染。使用PFGE，有14种不同的菌株类型确定，与USA 300是最常见的（31%）。Conclusions.目前的策略，以防止infectionincluding积极识别和非殖民化的MRSA-殖民化的acidatesare不足，因为婴儿发展感染之前被确定为殖民化或尝试后殖民化。未来的预防工作将受益于改善MRSA定植的检测，优化去殖民化方案，以及识别和阻断传播宿主。
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 infectionsincluding active identification and decolonization of MRSA-colonized neonatesare 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.