Surveillance for Colonization, Transmission, and Infection With Methicillin-Susceptible Staphylococcus aureus in a Neonatal Intensive Care Unit.
Surveillance for Colonization, Transmission, and Infection With Methicillin-Susceptible Staphylococcus aureus in a Neonatal Intensive Care Unit.
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DOI：
10.1001/jamanetworkopen.2021.24938
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发表时间：
2021-09-01
影响因子：
13.8
通讯作者：
Boutin S
中科院分区：
文献类型：
--
作者：
Nurjadi D;Eichel VM;Tabatabai P;Klein S;Last K;Mutters NT;Pöschl J;Zanger P;Heeg K;Boutin S
在新生儿重症监护病房获得甲氧西林敏感金黄色葡萄球菌（MSSA）定植和感染的危险因素是什么？在这项对590名新生儿的队列研究中，对金黄色葡萄球菌定植和感染的获得进行监测，直到出院。MSSA定植与出生体重较低、住院时间较长以及住院期间获得金黄色葡萄球菌感染的几率较高有关。这些发现表明，鼻腔定植是非爆发新生儿重症监护病房环境中MSSA感染的相关危险因素。本队列研究分析了单一新生儿重症监护病房（NICU）患者中甲氧西林敏感金黄色葡萄球菌（MSSA）的定植和感染事件，并评估了spa分型和全基因组测序在常规金黄色葡萄球菌监测中的作用。金黄色葡萄球菌是新生儿重症监护病房（NICUs）感染的主要原因之一。该患者组的大多数研究集中于耐甲氧西林金黄色葡萄球菌或爆发环境，而甲氧西林敏感金黄色葡萄球菌的数据有限。确定住院新生儿金黄色葡萄球菌定植和感染的危险因素，并调查金黄色葡萄球菌在非疫情环境中的传播及其动态。这项在德国海德堡第三期新生儿重症监护室进行的单中心队列研究纳入了所有住院新生儿（n = 590），其中至少有1例鼻拭子金黄色葡萄球菌筛查阳性。数据采集时间为2018年1月1日至2019年12月31日。每周对所有新生儿进行金黄色葡萄球菌定植筛查，直至出院。主要终点为出院前的任何金黄色葡萄球菌感染。金黄色葡萄球菌的传播和常规分型检测传播的表现被定义为研究的次要结果。共纳入590例新生儿，其中女性276例（46.8%），男性314例（53.2%），出生体重<1500 g 220例（37.3%），早产477例（80.8%），单胎449例（76.1%），剖宫产419例（71.5%）。中位住院时间为26天（范围10-62天）。总体而言，135名婴儿（22.9%）在住院期间被金黄色葡萄球菌定植。首次检测的中位时间为17天（四分位数间距为11-37天）。金黄色葡萄球菌感染的总发生率为1.7%（590例中有10例）。低出生体重（<1500 g[比值比，9.3;95% CI, 5.9-14.6; P < 0.001]）和较长的住院时间（比值比，2.3;95% CI, 1.9-2.7; P < 0.001）与定植有关。鼻载与金黄色葡萄球菌感染显著相关（优势比为8.2；95% CI为2.1 ~ 32.3;P = 0.002）。对135株定植分离株中的123株进行了测序。所有具有定植的新生儿可恢复感染分离株（7个中的4个）在遗传上与定植分离株相同。全基因组测序显示有23个潜在的传播集群。这项队列研究的结果表明，在非疫情的NICU环境中，鼻腔定植是金黄色葡萄球菌感染的相关危险因素。在定植的新生儿中，感染和定植分离物在遗传上是相同的，这表明根除定植可能是预防感染的有用措施。进一步的调查是必要的，以验证和评估我们的发现的普遍性。
What are the risk factors for the acquisition of methicillin-susceptible Staphylococcus aureus (MSSA) colonization and infections in a neonatal intensive care unit? In this cohort study of 590 newborns, the acquisition of S aureus colonization and infection was monitored until hospital discharge. Colonization with MSSA was associated with lower birth weight, longer hospitalization, and higher odds of acquiring S aureus infection during hospitalization. These findings suggest that nasal colonization is a relevant risk factor for MSSA infection in a nonoutbreak neonatal intensive care unit setting. This cohort study analyzes methicillin-susceptible Staphylococcus aureus (MSSA) colonization and infection events among patients in a single neonatal intensive care unit (NICU) and assesses the performance of spa typing and whole-genome sequencing for routine S aureus surveillance. Staphylococcus aureus is one of the leading causes of infections in neonatal intensive care units (NICUs). Most studies in this patient group focus on methicillin-resistant S aureus or the outbreak setting, whereas data for methicillin-susceptible S aureus are limited. To identify risk factors for S aureus colonization and infections in hospitalized newborns and to investigate S aureus transmission and its dynamics in a nonoutbreak setting. This monocentric cohort study in a tertiary NICU in Heidelberg, Germany, enrolled all hospitalized neonates (n = 590) with at least 1 nasal screening swab positive for S aureus. Data were collected from January 1, 2018, to December 31, 2019. Weekly screening for S aureus colonization was performed for all newborns until discharge. The primary end point was any S aureus infection until hospital discharge. Transmission of S aureus and performance of routine typing to detect transmissions were defined as the secondary outcomes of the study. In total, 590 newborns were enrolled (276 [46.8%] female and 314 [53.2%] male; 220 [37.3%] with birthweight <1500 g; 477 [80.8%] preterm; 449 [76.1%] singletons; 419 [71.5%] delivered via cesarean section). The median length of stay was 26 (range, 10-62) days. Overall, 135 infants (22.9%) were colonized by S aureus at some time during their hospital stay. The median time to first detection was 17 (interquartile range, 11-37) days. The overall incidence of S aureus infection was 1.7% (10 of 590). Low birth weight (<1500 g [odds ratio, 9.3; 95% CI, 5.9-14.6; P < .001]) and longer hospital stay (odds ratio, 2.3; 95% CI, 1.9-2.7; P < .001) were associated with colonization. Nasal carriage was significantly associated with S aureus infection (odds ratio, 8.2; 95% CI, 2.1-32.3; P = .002). A total of 123 of 135 colonization isolates were sequenced. All recoverable infection isolates (4 of 7) of newborns with colonization were genetically identical to the colonizing isolate. Whole-genome sequencing indicated 23 potential transmission clusters. The findings of this cohort study suggest that nasal colonization is a relevant risk factor for S aureus infection in a nonoutbreak NICU setting. In colonized newborns, infection and colonization isolates were genetically identical, suggesting that eradication of colonization may be a useful measure to prevent infection. Further investigations are necessary to validate and assess the generalizability of our findings.
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影响因子：
5.5
作者：
Romano-Bertrand S;Filleron A;Mesnage R;Lotthé A;Didelot MN;Burgel L;Jumas Bilak E;Cambonie G;Parer S
通讯作者：
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作者：
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作者：
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作者：
Bankevich, Anton;Nurk, Sergey;Pevzner, Pavel A.
通讯作者：
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