Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis
Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis
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DOI：
10.1086/504933
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发表时间：
2006-06-01
影响因子：
4.5
通讯作者：
Goldfarb, Johanna
中科院分区：
文献类型：
--
作者：
Bertin, Mary L.;Vinski, Joan;Goldfarb, Johanna
Objective.描述在新生儿重症监护病房（NICU）中控制耐甲氧西林金黄色葡萄球菌（MRSA）定植和感染爆发所需的调查和干预措施。回顾性病例发现，涉及前瞻性进行监测培养，以检测MRSA并通过重复序列聚合酶链反应（rep-PCR）对MRSA进行分子分型。设置。三级护理中心的三级新生儿重症监护室。2004年4月16日，新生儿重症监护病房的三名新生儿被确定为MRSA血流感染。一项时点患病率调查确定了另外6例定植新生儿（发病率，75% [ 9/12例新生儿]）。爆发菌株是表型异常。在爆发期间获得MRSA的新生儿开始了队列和莫匹罗星治疗。在NICU引入了接触预防措施，并对医护人员（HCW）进行了清洁和消毒程序以及手部卫生的再培训。非定植的新生儿和新入院的患者每周进行3次监测培养。1个月后发现2例新的定植新生儿。HCW X自2003年6月以来一直在NICU工作，被确定患有慢性中耳炎。从HCW X耳道和鼻孔的拭子标本培养物中分离出MRSA。HCW X在流行病学上与此次疫情有关。分子分型（rep-PCR）证实，从HCW X和新生儿的分离物超过90%的相似性。对新生儿重症监护室分离株的回顾性审查显示，暴发菌株最初是在HCW X开始在该单位工作后2个月从新生儿培养的。从NICU的患者护理中删除HCW X后，流行菌株被根除。新生儿重症监护病房MRSA定植和感染的爆发在流行病学上与慢性外耳炎HCW和MRSA鼻腔定植有关。直到将HCW X从NICU中移除才实现根除。对MRSA的常规监测可能有助于更早地识别疫情，现在已成为我们NICU的标准做法。
Objective. To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).Design. Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).Setting. Level III NICU in a tertiary care center.Participants. Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates ( attack rate, 75% [ 9 of 12 neonates]). The outbreak strain was phenotypically unusual.Interventions. Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.Results. Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing ( by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.Conclusion. An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.