An investigation of the risk factors for infection with methicillin-resistant Staphylococcus aureus among patients in a neonatal intensive care unit

Sakaki, Haruyo; Nishioka, Midori; Kobayashi, Katsuya; Takahashi, Yasuko

doi:10.1016/j.ajic.2009.02.008

Cited by 53 publications

(37 citation statements)

References 34 publications

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“…Whether MRSA infection rates would have been higher had the program not been in place is speculative. However, rates of colonization, a known risk factor for infection (8,26), significantly declined and remained low. Since Healy et al published the first report of CA-MRSA infections in NICU patients in 2004 (27), other NICUs have observed similar shifts from HA-MRSA strains to CA-MRSA strains (9,10,12).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program

et al. 2015

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1, 2). The National Nosocomial Infections Surveillance System observed a Ͼ300% increase in the incidence of late-onset MRSA infections in NICUs, from 0.7 to 3.1 infections/10,000 patient days, between 1995 and 2004 (3). Unique host and environmental factors, including immature immune systems, high frequency of contact with health care providers (4), exposure to numerous invasive procedures, NICU overcrowding and understaffing (5, 6), and prolonged hospitalization (7), make NICU patients at especially high risk of becoming colonized and infected with MRSA. Since colonization with MRSA is a risk factor for development of MRSA infection, prevention of MRSA transmission within the NICU is critical (7,8). Many NICUs have implemented active detection and isolation (ADI) programs, which involve surveillance to rapidly identify affected patients, followed by cohorting and isolation with standard contact precautions, in attempts to prevent MRSA transmission and reduce infection rates.Several large NICUs have published reports regarding the clinical epidemiology of neonatal MRSA following implementation of surveillance, transmission prevention, and/or decolonization strategies (7,(9)(10)(11)(12). Some also incorporated molecular analyses in their studies, including antibiotic susceptibility testing (9, 10), strain typing (9, 11, 12), genotyping (9, 12), and/or Panton-Valentine leukocidin gene detection (9,12). No studies have comprehensively examined all of those molecular features of MRSA and additionally assessed the presence or absence of genes encoding proteins for a variety of staphylococcal toxins and potential virulence factors over an extensive time period following implementation of an ADI program in an NICU.In response to the appearance of MRSA in the NICU at YaleNew Haven Children's Hospital (YNHCH)

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Section: Discussionmentioning

confidence: 99%

“…Whether infection rates would have been higher had the program not been in place is unknown. MRSA colonization is a known risk factor for subsequent development of infection (8,26). Factors other than the ADI program may have influenced infection rates.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program

et al. 2015

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“…This finding is in line with research from Japan that found kangaroo mother care on the neonatal intensive care unit (NICU), although perceived to protect against infectious disease outcomes by increasing the diversity of the baby's microbiome, 5 to be associated with 3.82-fold increased odds of MRSA infection (95% confidence interval, 1.11-13.13). 6 Searching for the source of MRSA, a medical history among family members revealed recurrent SSTIs in the father and the 4-year-old sister of the index case patient. Swabs of the father's nose and from a resolving purulent SSTI on the sister's leg screened positive for PVL + MRSA.…”

Section: Mrsa Colonizationmentioning

confidence: 99%

“…4 Noroviruses are surprisingly resistant to harsh environmental conditions, and they are widely recognized as the leading cause of viral gastroenteritis due to foodborne infection across all age groups. [5][6][7] The diagnosis of norovirus gastroenteritis cannot be made based on clinical features alone, and the widespread availability of molecular diagnostic tests has resulted in an increased awareness of norovirus-associated acute gastroenteritis worldwide. Because no vaccines or specific antiviral agents are currently available for the prevention or treatment of norovirus infection, rigorous hygiene (eg, hand washing) and heat treatment of foods and water remain the main prevention measures to combat norovirus figure 1.…”

Section: Multiple Norovirus Outbreaks Due To Shredded Dried Laver Smentioning

confidence: 99%

Transmission of ST8-USA300 Latin American Variant Methicillin-Resistant Staphylococcus aureus on a Neonatal Intensive Care Unit: Recurrent Skin and Soft- Tissue Infections as a Marker for Epidemic Community-Associated-MRSA Colonization

Nurjadi

Klein

Zimmermann

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…42 These effects highlight the importance of previous colonization in development of MRSA infections in both populations. The intrinsic characteristics of newborn patients such as the immunologic immaturity, as well as the complexity of care needed in the majority of neonates hospitalized in NICUs, [55][56][57] appear to render this population vulnerable to hospital-acquired infections and underscore the significance of the estimated colonization rate.…”

Section: Figurementioning

confidence: 99%

MRSA Colonization and Risk of Infection in the Neonatal and Pediatric ICU: A Meta-analysis

Zervou

Zacharioudakis

Ziakas³

et al. 2014

Pediatrics

102

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BACKGROUND AND OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality in NICUs and PICUs. Our objective was to assess the burden of MRSA colonization on admission, study the time trends, and examine the significance of MRSA colonization in this population. METHODS:PubMed and Embase databases were consulted. Studies that reported prevalence of MRSA colonization on ICU admission were selected. Two authors independently extracted data on MRSA colonization and infection. RESULTS:We identified 18 suitable articles and found an overall prevalence of MRSA colonization of 1.9% (95% confidence interval [CI] 1.3%-2.6%) on admission to the NICU or PICU, with a stable trend over the past 12 years. Interestingly, 5.8% (95% CI 1.9%-11.4%) of outborn neonates were colonized with MRSA on admission to NICU, compared with just 0.2% (95% CI 0.0%-0.9%) of inborn neonates (P = .01). The pooled acquisition rate of MRSA colonization was 4.1% (95% CI 1.2%-8.6%) during the NICU and PICU stay and was as high as 6.1% (95% CI 2.8%-10.6%) when the NICU population was studied alone. There was a relative risk of 24.2 (95% CI 8.9-66.0) for colonized patients to develop a MRSA infection during hospitalization. CONCLUSIONS:In the NICU and PICU, there are carriers of MRSA on admission, and MRSA colonization in the NICU is almost exclusively associated with outborn neonates. Importantly, despite infection control measures, the acquisition rate is high, and patients colonized with MRSA on admission are more likely to suffer a MRSA infection during hospitalization.

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An investigation of the risk factors for infection with methicillin-resistant Staphylococcus aureus among patients in a neonatal intensive care unit

Cited by 53 publications

References 34 publications

Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program

Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program

Transmission of ST8-USA300 Latin American Variant Methicillin-Resistant Staphylococcus aureus on a Neonatal Intensive Care Unit: Recurrent Skin and Soft- Tissue Infections as a Marker for Epidemic Community-Associated-MRSA Colonization

MRSA Colonization and Risk of Infection in the Neonatal and Pediatric ICU: A Meta-analysis

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