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Am J Perinatol 2024; 41(S 01): e1337-e1343
DOI: 10.1055/s-0043-1763481
Original Article

Effects of Discontinuation of Weekly Surveillance Testing on Methicillin-Resistant Staphylococcus aureus in the NICU

Rebecca Y. Petersen
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
,
Noah H. Hillman
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
,
Farouk H. Sadiq
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
,
Christopher A. Brownsworth
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
,
Howard L. Williams
2   Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
,
Justin B. Josephsen 
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
› Author Affiliations Funding Department of Pediatrics, Saint Louis University and SSM Health Cardinal Glennon Children's Foundation provided funding for this study.
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Abstract

Objective Methicillin-resistant Staphylococcus aureus (MRSA) infection is a major cause of serious morbidity and mortality in the neonatal intensive care unit (NICU). There is no clear consensus on infection control measures. Some approaches to MRSA colonization management may be burdensome with unclear benefits. The objective of this study was to determine if stopping weekly MRSA surveillance with active detection and contact isolation (ADI) was associated with a change in infection rate.

Study Design This is a retrospective cohort study of infants admitted to two affiliated NICUs. The ADI cohort infants received weekly nasal MRSA cultures and were placed in contact isolation if MRSA colonized for the duration of their hospitalization. The No Surveillance cohort infants were only placed in isolation if there was active MRSA infection or if MRSA colonization was identified incidentally. The rates of infection were determined between the cohorts.

Results There were 8,406 neonates representing 193,684 NICU days in the comparison period. In the ADI cohort, MRSA colonization occurred in 3.4% of infants and infection occurred in 29 infants (0.4%). There were no differences between cohorts in the percent of infants with a MRSA infection at any site (0.5 vs. 0.5%, p = 0.89), rate of MRSA infections per 1,000 patient-days (0.197 vs. 0.201, p = 0.92), rate of bloodstream infections (0.12 vs. 0.26%, p = 0.18), or in the overall mortality rate (3.7 vs. 3.0% p = 0.13). ADI represented an annual cost of $590,000.

Conclusion The rates of MRSA infection did not change when weekly ADI was discontinued and was associated with a decrease in cost and resource utilization.

Key Points

  • Placing MRSA-colonized infants in contact isolation is a common practice.

  • Data are limited with respect to efficacy in the NICU.

  • This study provides evidence that active detection and contact isolation for MRSA colonization may not be beneficial.

Keywords

methicillin-resistant Staphylococcus aureus - surveillance - contact isolation


Publication History

Received: 26 September 2022

Accepted: 12 January 2023

Article published online:
27 February 2023

© 2023. Thieme. All rights reserved.

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