Clinical characteristics and antibiotic resistance profile of invasive MRSA infections in newborn inpatients: a retrospective multicenter study from China

Abstract

Background Methicillin-resistant Staphylococcus aureus (MRSA) can cause invasive infections with significant mortality in neonates. This study aimed to analyze the clinical characteristics and antibiotic resistance profiles of invasive MRSA infections and determine risk factors associated with invasive MRSA infections in newborn inpatients. Methods This multicenter retrospective study of inpatients from eleven hospitals in the Infectious Diseases Surveillance of Pediatrics (ISPED) group of China was performed over a two-year period (2018–2019). Statistical significance was calculated by applying the χ2 test or by Fisher’s exact test in the case of small sample sizes. Results A total 220 patients were included. Among included cases, 67 (30.45%) were invasive MRSA infections, including two deaths (2.99%), while 153 (69.55%) were noninvasive infections. The invasive infections of MRSA occurred at a median age of 8 days on admission, which was significantly younger compared to 19 days in noninvasive cases. Sepsis (86.6%) was the most common invasive infection, followed by pneumonia (7.4%), bone and joint infections (3.0%), central nervous system infection (1.5%), and peritonitis (1.5%). Congenital heart disease, low birth weight infant (<2500 g), but not preterm neonates, and bronchopulmonary dysplasia, were more commonly found in invasive MRSA infections. All these isolates were susceptible to vancomycin and linezolid and were resistant to penicillin. Additionally, 69.37% were resistant to erythromycin, 57.66% to clindamycin, 7.04% to levofloxacin, 4.62% to sulfamethoxazole-trimethoprim, 4.29% to minocycline, 1.33% to gentamicin, and 3.13% were intermediate to rifampin. Conclusion Low age at admission (≤8 days), congenital heart disease, and low birth weight were associated with invasive MRSA infections in neonates, and no isolates resistant to vancomycin and linezolid were found. Determining these risks in suspected neonates may help identify patients with imminent invasive infections who may require intensive monitoring and therapy.

Neonatal methicillin-resistant Staphylococcus aureus pneumonia–related recurrent fatal pyopneumothorax: A case report and review of literature

“…The characteristics of MRSA pneumonia on chest imaging vary, including such features as pneumothorax[ 11 ], empyema[ 11 , 13 ], and pneumatoceles[ 11 , 14 - 15 ]. Neonatal MRSA infections usually occur in critically ill newborns with long-term hospitalization[ 16 - 17 ], such as extremely premature infants[ 18 - 19 ], low-birth-weight infants[ 17 , 20 ], term infants undergoing surgery[ 18 ], and neonates with congenital heart disease[ 17 ]. MRSA infections in newborns can also involve multiple systems ( e.g.…”

“…MRSA infections in newborns can also involve multiple systems ( e.g. , SSTIs[ 17 ], pneumonia[ 13 - 15 , 17 , 19 , 21 ], bacteremia[ 13 , 15 , 17 ], central nervous system infections[ 17 ], bone and joint infections[ 17 , 22 ], peritonitis[ 17 ], and liver abscess[ 23 ]) and cause related injuries that are severe and refractory[ 17 , 23 ].…”

“…Hospital-associated MRSA (HA-MRSA) infection is common[ 19 , 24 - 26 ], while community-acquired MRSA (CA-MRSA) infection[ 6 , 21 , 27 ], especially severe neonatal CA-MRSA refractory necrotizing pneumonia[ 13 , 15 ], is relatively rare. Although some neonates with MRSA pneumonia will recover[ 13 - 15 , 21 ], some cases cannot be cured[ 17 ]. Caregivers must pay attention to the importance of hand hygiene and other protective measures in the daily care of newborns and try to avoid MRSA infections in multiple ways[ 16 , 20 , 26 , 28 - 29 ].…”