Active Surveillance Cultures and Decolonization to Reduce Staphylococcus aureus Infections in the Neonatal Intensive Care Unit

Abstract

Background and Objectives Staphylococcus aureus (S. aureus) is a common cause of healthcare associated infections (HAI) in neonates. Our objectives were to examine the impact of S. aureus decolonization on the incidence of S. aureus infection and to measure the prevalence of mupirocin resistance. Methods We retrospectively identified neonates admitted to a tertiary care NICU between April 1 2011 and September 30 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used two measurements to identify the primary outcome, NICU-attributable MSSA: 1) any culture sent during routine clinical care that grew MSSA and 2) any culture that grew MSSA and met criteria of the NHSN's HAI surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. To determine the impact of the intervention on MSSA infection, we estimated incidence rate ratios using interrupted time series models. Results Pre- and post-intervention, 1523 neonates (29,220 patient-days) and 1195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures, of more than 60% (IRR=0.36, 95% CI 0.19, 0.70) after implementation of the intervention and MSSA positive culture rates continued to decrease by 21% per quarter (IRR 0.79 95% CI 0.74, 0.84). MSSA infections also decreased immediately following the intervention implementation (IRR=0.27; 95% CI=0.10, 0.79). No mupirocin resistance was detected. Conclusions Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.

Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible <b><i>Staphylococcus aureus</i></b> Infections in VLBW Infants

“…A high prevalence of mupirocin-resistant S. aureus strains was reported after the widespread use of mupirocin in adult ICU [18,19] but not in neonates so far [13,14]. In line with these reports, we did not detect mupirocin-resistant MSSA strains during the study period.…”

“…In the last decade, several active surveillance and decolonization strategies have shown promising results in the reduction of MRSA and MSSA infections in neonates [13,14,15]. However, data on safety and efficacy of active surveillance cultures and decolonization for MSSA-colonized VLBWI are still lacking.…”

“…Recently, Popoola et al [14] showed that an active surveillance and decolonization strategy at a tertiary-care NICU significantly decreased MSSA-attributable infections in neonates. The regimen used in their study, consisting of intranasal mupirocin for 5 days and 2 baths with 2% chlorhexidine gluconate applied 48 h apart for infants of >36 weeks' gestational age and a chronological age of >4 weeks was well tolerated.…”

Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme

“…First, our study was limited to MRSA, despite increased recognition of methicillin-sensitive Staphylococcus aureus as an important NICU pathogen, 31 for which decolonization strategies may be warranted. 32 Second, as is typical with characterizations of colonization pressure, our models aggregate risk over weekly intervals and therefore cannot inform the impact of variation in intensity of colonization pressure exposures during the seven-day exposure period. Additional limitations include the inability to generalize to patient populations with short length of stay and the lack of longitudinal molecular data to confirm transmission source.…”

Association of an Active Surveillance and Decolonization Program on Incidence of Clinical Cultures Growing Staphylococcus aureus in the Neonatal Intensive Care Unit

“…4 In April 2013, the program expanded to include MSSA screening and decolonization. Previously, we showed that after implementation of MSSA ASC and targeted decolonization, S. aureus clinical cultures and infections decreased.…”