Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey

Zingg, Walter; Hopkins, Susan; Gayet-Ageron, Angèle; Holmes, Alison; Sharland, Mike; Suetens, Carl; Almeida, María de Lourdes Guerrero; Asembergiene, Jolanta; Borg, Michael; Budimir, Ana; Cairns, Shona; Cunney, Robert; Deptuła, Aleksander; Berciano, Pilar Gallego; Guðlaugsson, Ólafur; Hadjiloucas, Avgi; Hammami, Naïma; Harrison, Wendy; Heisbourg, E.; Kolman, Jana; Kontopidou, Flora; Kristensen, Brian; Lyytikäinen, Outi; Märtin, Pille; McIlvenny, G.; Moro, Maria Luisa; Piening, Brar; Presterl, Elisabeth; Şerban, Roxana; Smid, E; Sorknes, Nina Kristine; Štefkovičová, Mária; Sviestiņa, Inese; Szabó, Rita; Tkadlecova, Hana; Vatcheva-Dobrevska, Rossitza; Verjat-Trannoy, D

doi:10.1016/s1473-3099(16)30517-5

Cited by 150 publications

(153 citation statements)

References 25 publications

(15 reference statements)

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“…Gram-negative pathogens are of particular concern as they account for a substantial portion of HAIs in the NICU and are associated with high morbidity and mortality. 1,14,22 In the current study, we did not observe a significant increase in the proportion, rate, or hazard of gram-negative bacilli infections with mupirocin treatment. In contrast, Perez-Fontan et al 23 previously reported an increase of gram-negative infections with nasal mupirocin use in adult peritoneal dialysis patients.…”

Section: Discussioncontrasting

confidence: 56%

“…1–3 Decolonization is a strategy to prevent S. aureus by reducing the bioburden of skin colonization that may otherwise increase risk of subsequent S.aureus infection or transmission. In neonatal intensive care units (NICUs), decolonization primarily has been used to control epidemic and endemic methicillin-resistant S. aureus (MRSA).…”

mentioning

confidence: 99%

“…15 The possibility of organism replacement after topical antibiotic ointment is particularly salient for infants in the NICU, as they are subject to recurrent pathogen introduction events from the healthcare setting and are particularly vulnerable to infections due to naive immune systems, a nascent microbiome, poor skin integrity, and frequent use of invasive devices. 1,16,17 …”

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confidence: 99%

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Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study

Pierce

Bryant

Elward

et al. 2017

Infect. Control Hosp. Epidemiol.

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Objective To characterize the risk of infection after Staphylococcus aureus decolonization with intranasal mupirocin. Design Multicenter, retrospective cohort study. Setting Tertiary care neonatal intensive care units (NICUs) from three urban hospitals in US. Bed size range: 45–100. Methods MRSA-colonized neonates were identified from NICU admissions occurring from January 2007–December 2014, during which a targeted decolonization strategy was used for MRSA control. In two time-to-event analyses, MRSA-colonized neonates were observed from date of first MRSA positive surveillance screen until 1) first occurrence of novel gram-positive cocci in sterile culture or discharge and 2) first occurrence of novel gram-negative bacilli in sterile culture or discharge. Mupirocin exposure was treated as time varying. Results A total of 522 MRSA-colonized neonates were identified from 16,144 neonates admitted to site NICUs. Of the MRSA-colonized neonates, 384 (74%) received mupirocin. Average time from positive culture to mupirocin treatment was 3.5 days (sd=7.2 days). The adjusted hazard of gram-positive cocci infection was 64% less among mupirocin-exposed versus mupirocin-unexposed neonates (HR=0.36, 95% CI: 0.17–0.76), while the adjusted hazard ratio of gram-negative bacilli infection comparing mupirocin-exposed and -unexposed neonates was 1.05 (95% CI: 0.42–2.62). Conclusions In this multi-centered cohort of MRSA-colonized neonates, mupirocin-based decolonization treatment appeared to decrease the risk of infection with select gram-positive organisms, as intended, and was not significantly associated with risk of subsequent infections with organisms not covered by mupirocin’s spectrum of activity.

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Section: Discussioncontrasting

confidence: 56%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study

Pierce

Bryant

Elward

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…Neonates are especially susceptible to episodes of LOS due to an immature immune system, and they frequently require invasive devices, including central lines, to deliver life-saving medications and parenteral nutrition. The use of such devices significantly increases the risk of infection, and central line-associated bloodstream infections (CLABSIs) are an important cause of LOS 4. While there is some uncertainty regarding the impact of CLABSIs on neurological outcomes,1 recent evidence suggests that reductions in coagulase-negative staphylococcal (CoNS) infections may reduce cognitive disability in preterm infants 5…”

Section: Introductionmentioning

confidence: 99%

Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis

Payne

Hall

Prieto

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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There is a substantial body of quasi-experimental evidence to suggest that care bundles may reduce CLABSI rates in the NNU, though it is not clear which bundle elements are effective in specific settings. Future research should focus on determining what processes promote the effective implementation of infection prevention recommendations, and which elements represent essential components of such care bundles.

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“…Staphylococcus aureus remains one of the principal causes of HAI in children (8)(9)(10)(11). In S. aureus, the smr gene and the qacA/B gene complex have been associated with elevated MICs and minimum bactericidal concentrations (MBCs) of CHG. A number of investigators have discovered an increase in the incidence of organisms bearing these genes following widespread use of CHG in hospital units (12)(13)(14) and, more rarely, following exposure to CHG outside the hospital setting (15,16).…”

mentioning

confidence: 99%

Impact of Health Care Exposure on Genotypic Antiseptic Tolerance in Staphylococcus aureus Infections in a Pediatric Population

McNeil

Hultén

Mason

et al. 2017

Antimicrob Agents Chemother

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Staphylococcus aureus possessing either the smr gene or the qacA/B genes is associated with decreased susceptibility to chlorhexidine gluconate (CHG) and other antiseptics. Previous studies of antiseptic-tolerant staphylococci have focused largely on high-risk populations, and the exact role of health care exposure in the acquisition of these organisms is unclear. We sought to describe the risk factors and features of infection caused by antiseptic-tolerant S. aureus in a general pediatric population. Isolates were selected from an ongoing S. aureus surveillance study. Every third sequential isolate in the year 2014 was selected for inclusion. All isolates underwent PCR for the genes qacA/B and smr. Medical records were reviewed. Five hundred six isolates were included in the study, with 377 (74.3%) being community acquired. One hundred (19.8%) isolates were smr positive and 79 (15.6%) qacA/B positive. In univariable analyses, the presence of either gene was associated with underlying medical conditions, nosocomial acquisition, recent hospitalization, central venous lines, and CHG exposure. In multivariable analyses, only differences between patients with chronic medical conditions (odds ratio [OR] ϭ 1.72; 95% confidence interval [CI], 1.22 to 2.64) and nosocomial acquisition (OR ϭ 2.48; 95% CI, 1.16 to 8.17) remained statistically significant. Among patients without risk factors, 27.9% had infection with an antiseptic-tolerant isolate. smr-or qacA/B-positive S. aureus isolates are common in children and are independently associated with nosocomial acquisition and underlying medical conditions. These findings imply a role for the health care environment in acquisition of these organisms. However, genotypic antiseptic tolerance was seen in Ͼ25% of healthy children with an S. aureus infection, indicating that these organism are prevalent in the community as well.

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Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey

Abstract: Background: In 2011/2012, the European Centre for Disease Prevention and Control

Cited by 150 publications

References 25 publications

Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study

Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study

Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis

Impact of Health Care Exposure on Genotypic Antiseptic Tolerance in Staphylococcus aureus Infections in a Pediatric Population

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