Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge.
Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge.
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DOI：
10.1016/j.cmi.2016.04.013
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发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Fritz SA
中科院分区：
文献类型：
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作者：
Reich PJ;Boyle MG;Hogan PG;Johnson AJ;Wallace MA;Elward AM;Warner BB;Burnham CA;Fritz SA
耐甲氧西林金黄色葡萄球菌（MRSA）感染在新生儿重症监护病房（NICUs）引起显著的发病率和死亡率。我们描述了MRSA菌株定植在NICU患者的临床和分子流行病学。2009-2014年通过主动监测获得的96例新生儿重症监护病房（NICU）患者鼻MRSA分离株250株，采用葡萄球菌盒式染色体mec （SCCmec）分型、mupA（高水平莫匹罗星耐药标志物）和qacA/B（氯己定耐药相关标志物）检测。评估与社区相关（CA-）或医疗保健相关（HA-） MRSA相关的因素。MRSA鼻腔定植的总体流行率为3.9%。在我们回顾性队列的96名新生儿中，60名（63%）定植了CA-MRSA菌株，35名（36%）定植了HA-MRSA菌株。HA-MRSA定植的患者比CA-MRSA定植的患者更容易发生MRSA感染（13/35[37%]对8/60 [13%]，p=0.007），尽管CA-MRSA定植的婴儿从定植到感染的时间间隔较短（0天[范围- 1至4]，HA-MRSA定植的婴儿为7天[- 1至43]，p=0.005）。产妇围产期抗生素与CA-MRSA定植相关（调整优势比[aOR] 8.7； 95%可信区间[CI] 1.7, 45.0）；插管和外科手术与HA-MRSA定植相关（aOR 7.8； 95% CI分别为1.3、47.6和aOR 6.0； 95% CI分别为1.4、24.4）。分别从4例和8例患者中分离到对莫匹罗星和氯己定耐药的MRSA；携带一种对莫匹罗星耐药的菌株阻碍了去菌落。CA-MRSA菌株在新生儿重症监护室突出，并与不同的危险因素相关。鉴于MRSA获得和传播的社区宿主，需要新的感染预防策略。
Methicillin-resistant Staphylococcus aureus (MRSA) infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). We characterized the clinical and molecular epidemiology of MRSA strains colonizing NICU patients. Nasal MRSA isolates (n=250, from 96 NICU patients) recovered through active surveillance from 2009-2014 were characterized with Staphylococcal cassette chromosome mec (SCCmec) typing and detection of mupA (marker of high-level mupirocin resistance) and qacA/B (marker associated with chlorhexidine resistance). Factors associated with community-associated (CA-) or healthcare-associated (HA-) MRSA were evaluated. The overall prevalence of MRSA nasal colonization was 3.9%. Of 96 neonates in our retrospective cohort, 60 (63%) were colonized with CA-MRSA strains and 35 (36%) were colonized with HA-MRSA strains. Patients colonized with HA-MRSA were more likely to develop MRSA infections than patients colonized with CA-MRSA (13/35 [37%] vs. 8/60 [13%], p=0.007), although the interval from colonization to infection was shorter in CA-MRSA-colonized infants (0 days [range −1 to 4] versus HA-MRSA-colonized infants, 7 days [−1 to 43], p=0.005). Maternal peripartum antibiotics were associated with CA-MRSA colonization (adjusted odds ratio [aOR] 8.7; 95% confidence interval [CI] 1.7, 45.0); intubation and surgical procedures were associated with HA-MRSA colonization (aOR 7.8; 95% CI 1.3, 47.6 and aOR 6.0; 95% CI 1.4, 24.4, respectively). Mupirocin- and chlorhexidine-resistant MRSA was isolated from 4 and 8 patients, respectively; carriage of a mupirocin-resistant strain precluded decolonization. CA-MRSA strains are prominent in the NICU and associated with distinct risk factors. Given community reservoirs for MRSA acquisition and transmission, novel infection prevention strategies are needed.