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Am J Perinatol 2012; 29(06): 401-408
DOI: 10.1055/s-0032-1304819
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Staphylococcus aureus, including Community-Acquired Methicillin-resistant S. aureus, in a Level III NICU: 2001 to 2008

Divya Rana
1   Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Nazha Abughali
1   Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Deepak Kumar
1   Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Dennis M. Super
1   Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Michael R. Jacobs
2   Department of Pathology, Case Western Reserve University, Cleveland, Ohio
,
Mary L. Kumar
1   Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

20 May 2011

12 December 2011

Publication Date:
07 March 2012 (online)

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Abstract

Objective To determine epidemiology and clinical characteristics of infants with methicillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) in a level III neonatal intensive care unit (NICU).

Study Design All NICU admissions (2001 to 2008) with any positive S. aureus culture were included as cases. Cases were further characterized as either colonized or infected with invasive disease.

Results Four thousand three hundred four infants were admitted; 273 (6.3%) had at least one culture positive for S. aureus, including 198 with MSSA and 75 with MRSA. Invasive disease occurred in 23.2% of MSSA cases versus 29.3% MRSA (p = 0.298). Between the study periods 2001 to 2005 versus 2006 to 2008, the incidence of all MSSA cultures (colonization and invasive disease) decreased from 53.6 to 38.9/1000 admissions (p = 0.044), and that of MRSA increased from 13.7 to 24.77/1000 admissions (p = 0.010). The incidence of invasive MSSA (p = 0.49) and MRSA (p = 0.38) disease between the two periods remained similar. Infants with invasive MRSA versus MSSA had a longer duration of positive cultures (55 versus 19 days, p = 0.009). None of five available isolates collected prior to 2006 was characterized as USA300, but 11/21 isolates collected subsequently were USA300 (p = 0.053).

Conclusion The incidence of MRSA (colonization and infection) nearly doubled during the study period coinciding with emergence of community-acquired MRSA USA300.

Keywords

Staphylococcus aureus - MRSA - preterm - NICU
 

  • References

  • 1 Stoll BJ, Hansen N, Fanaroff AA , et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1) 285-291
    CrossrefPubMedGoogle Scholar
  • 2 Herold BC, Immergluck LC, Maranan MC , et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279: 593-598
    CrossrefPubMedGoogle Scholar
  • 3 Centers for Disease Control and Prevention (CDC). Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus—Minnesota and North Dakota, 1997–1999. Morb Mortal Wkly Rep 1999; 48: 707-710
    PubMedGoogle Scholar
  • 4 Popovich KJ, Weinstein RA, Hota B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains?. Clin Infect Dis 2008; 46: 787-794
    CrossrefPubMedGoogle Scholar
  • 5 Saiman L, O’Keefe M, Graham III PL , et al. Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003; 37: 1313-1319
    CrossrefPubMedGoogle Scholar
  • 6 Bratu S, Eramo A, Kopec R , et al. Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis 2005; 11 (6) 808-813
    CrossrefPubMedGoogle Scholar
  • 7 Zaoutis TE, Toltzis P, Chu J , et al. Clinical and molecular epidemiology of community-acquired methicillin-resistant Staphylococcus aureus infections among children with risk factors for health care-associated infection: 2001–2003. Pediatr Infect Dis J 2006; 25: 343-348
    PubMedGoogle Scholar
  • 8 Healy CM, Hulten KG, Palazzi DL, Campbell JR, Baker CJ. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004; 39: 1460-1466
    CrossrefPubMedGoogle Scholar
  • 9 Gregory ML, Eichenwald EC, Puopolo KM. Seven-year experience with a surveillance program to reduce methicillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit. Pediatrics 2009; 123: e790-e796
    CrossrefPubMedGoogle Scholar
  • 10 Lessa FC, Edwards JR, Fridkin SK, Tenover FC, Horan TC, Gorwitz RJ. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995–2004. Pediatr Infect Dis J 2009; 28 (7) 577-581
    CrossrefPubMedGoogle Scholar
  • 11 McDougal LK, Steward CD, Killgore GE, Chaitram JM, McAllister SK, Tenover FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003; 41 (11) 5113-5120
    CrossrefPubMedGoogle Scholar
  • 12 Seybold U, Kourbatova EV, Johnson JG , et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006; 42: 647-656
    CrossrefPubMedGoogle Scholar
  • 13 Moran GJ, Krishnadasan A, Gorwitz RJ , et al; EMERGEncy ID Net Study Group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006; 355: 666-674
    CrossrefPubMedGoogle Scholar
  • 14 Fridkin SK, Hageman JC, Morrison M , et al; Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005; 352: 1436-1444
    CrossrefPubMedGoogle Scholar
  • 15 Yee-Guardino S, Kumar D, Abughali N, Tuohy M, Hall GS, Kumar ML. Recognition and treatment of neonatal community-associated MRSA pneumonia and bacteremia. Pediatr Pulmonol 2008; 43: 203-205
    CrossrefPubMedGoogle Scholar
  • 16 Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16: 128-140
    CrossrefPubMedGoogle Scholar
  • 17 Clinical and Laboratory Standards Institute : Performance Standards for Antimicrobial Susceptibility Testing: Fourteenth Informational Supplement. NCCLS document M100–S14. Wayne, PA: Clinical and Laboratory Standards Institute; 2004
    Google Scholar
  • 18 Tenover FC, Arbeit RD, Goering RV , et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33: 2233-2239
    PubMedGoogle Scholar
  • 19 Styers D, Sheehan DJ, Hogan P, Sahm DF. Laboratory based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann Clin Microbiol Antimicrob 2006; 5 (2) 1-9
    CrossrefPubMedGoogle Scholar
  • 20 Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39: 309-317
    CrossrefPubMedGoogle Scholar
  • 21 Carey AJ, Duchon J, Della-Latta P, Saiman L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000–2007. J Perinatol 2010; 30: 135-139
    CrossrefPubMedGoogle Scholar
  • 22 Chen KT, Campbell H, Borrell LN, Huard RC, Saiman L, Della-Latta P. Predictors and outcomes for pregnant women with vaginal-rectal carriage of community-associated methicillin-resistant Staphylococcus aureus . Am J Perinatol 2007; 24: 235-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Geva A, Wright SB, Baldini LM, Smallcomb JA, Safran C, Gray JE. Spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: network analysis. Pediatrics 2011; 128 (5) e1173-e1180
    CrossrefPubMedGoogle Scholar
  • 24 Chen KT, Huard RC, Della-Latta P, Saiman L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006; 108 (3 Pt 1) 482-487
    CrossrefPubMedGoogle Scholar
  • 25 Top KA, Huard RC, Fox Z , et al. Trends in methicillin-resistant Staphylococcus aureus anovaginal colonization in pregnant women in 2005 versus 2009. J Clin Microbiol 2010; 48: 3675-3680
    CrossrefPubMedGoogle Scholar
  • 26 Maraqa NF, Aigbivbalu L, Masnita-Iusan C , et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control 2011; 39: 35-41
    CrossrefPubMedGoogle Scholar
  • 27 Seybold U, Halvosa JS, White N, Voris V, Ray SM, Blumberg HM. Emergence of and risk factors for methicillin-resistant Staphylococcus aureus of community origin in intensive care nurseries. Pediatrics 2008; 122: 1039-1046
    CrossrefPubMedGoogle Scholar
  • 28 Dudeck MA, Horan TC, Peterson KD , et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011; 39: 349-367
    CrossrefPubMedGoogle Scholar
  • 29 Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR ; Pediatric Prevention Network. Nosocomial infection rates in US children's hospitals’ neonatal and pediatric intensive care units. Am J Infect Control 2001; 29: 152-157
    CrossrefPubMedGoogle Scholar
  • 30 National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470-485
    CrossrefPubMedGoogle Scholar
  • 31 Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003; 112 (6 Pt 1) 1283-1289
    CrossrefPubMedGoogle Scholar
  • 32 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332
    CrossrefPubMedGoogle Scholar
  • 33 Cordero L, Ayers LW, Miller RR, Seguin JH, Coley BD. Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants. Am J Infect Control 2002; 30: 32-39
    CrossrefPubMedGoogle Scholar
  • 34 Labenne M, Poyart C, Rambaud C , et al. Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med 1999; 27: 2537-2543
    CrossrefPubMedGoogle Scholar
  • 35 Gauvin F, Dassa C, Chaïbou M, Proulx F, Farrell CA, Lacroix J. Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods. Pediatr Crit Care Med 2003; 4: 437-443
    CrossrefPubMedGoogle Scholar
  • 36 Katayama Y, Minami H, Enomoto M, Takano T, Hayashi S, Lee YK. Usefulness of Gram staining of tracheal aspirates in initial therapy for ventilator-associated pneumonia in extremely preterm neonates. J Perinatol 2010; 30: 270-274
    CrossrefPubMedGoogle Scholar
  • 37 Abramson MA, Sexton DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs?. Infect Control Hosp Epidemiol 1999; 20: 408-411
    CrossrefPubMedGoogle Scholar
  • 38 Kuint J, Barzilai A, Regev-Yochay G, Rubinstein E, Keller N, Maayan-Metzger A. Comparison of community-acquired methicillin-resistant Staphylococcus aureus bacteremia to other staphylococcal species in a neonatal intensive care unit. Eur J Pediatr 2007; 166: 319-325
    CrossrefPubMedGoogle Scholar