Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment

Hitomi, Shigemi; Kubota, Masaya; Mori, Namiko; Baba, Shigeyoshi; Yano, Hisako; Okuzumi, Katsuko; Kimura, Satoshi

doi:10.1053/jhin.2000.0786

Cited by 67 publications

(36 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pharmacologic agents have been used with some success, particularly with intranasal mupirocin for methicillin resistant Staphylococcus aureus. 16 The reduction of CoNS infections observed in this study after implementation of CIC measures is comparable to the first postintervention year benefit realized in multicenter implementation of 'best practices' by Horbar et al 4 and Kilbride et al 5 There are limited data on the long-term effects of such interventions and changes in infection control practices.…”

Section: Discussionsupporting

confidence: 74%

Sustained reductions in neonatal nosocomial infection rates following a comprehensive infection control intervention

et al. 2005

View full text Add to dashboard Cite

Objective: Nosocomial infections (NI) are a frequent and important cause of morbidity and mortality in newborn infants who receive intensive care. We sought to determine if comprehensive infection control (CIC) measures decrease rates in a large neonatal intensive care nursery.Methods: Single center interventional study. The CIC intervention consisted of increasing nursing and physician education and awareness of infection rates, establishing common improvement goals, training in hand and environment care, and implementing a specialty nursing team for central venous and arterial catheter care. Demographic and microbiology information for all infants admitted to the NICU from Results: Baseline infection rate was 8.5 per 1000 hospital days. The NI rate fell 26% (P ¼ 0.002) from baseline in the first year and 29% (P<0.001) in the second and third years after the CIC intervention. The reduction in total NI was due mostly to a 46% fall in coagulase-negative Staphylococcus infection rate (P<0.001); however, rates of all other organisms also fell by 21% (P ¼ 0.05).Conclusions: CIC measures can reduce bacterial and fungal NI rates. This effect has been sustained for 3 years following the intervention.

show abstract

Section: Discussionsupporting

confidence: 74%

Sustained reductions in neonatal nosocomial infection rates following a comprehensive infection control intervention

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Of the patients who were decolonized, 52.5% achieved decolonization while hospitalized and receiving medical treatment to eradicate the colonization, whereas the remaining 47.5% were decolonized in the community without specific medical treatment. The median time to decolonization was about 6-7 times longer among the discharged neonates than among the hospitalized neonates, suggesting that despite differences in follow-up intervals, in-hospital medical treatments, such as bathing with 0.5% chlorhexidine, may have decreased the total duration of MRSA colonization [17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes in Methicillin-Resistant <i>Staphylococcus aureus-</i>Colonized Neonates in the Neonatal Intensive Care Unit

Kim

Chang²,

Kim³

et al. 2006

Neonatology

View full text Add to dashboard Cite

Background: Methicillin-resistent Staphylococcus aureus (MRSA) colonization can persist for prolonged periods, and patient-related factors are associated with persistent carriage in adults. However, such knowledge is lacking among neonates. Objectives: To better understand the outcome of MRSA-colonized neonates in the neonatal intensive care unit (NICU), we prospectively followed all colonized neonates until decolonization over 39 months and determined the incidence, duration of colonization, clinical outcomes and risk factors associated with prolonged carriage of MRSA. Methods: Nasal and inguinal cultures were obtained from all newly admitted neonates following an outbreak of MRSA. Weekly and 1–2 monthly cultures were obtained from all hospitalized and discharged neonates colonized with MRSA, respectively, until 2 consecutive cultures were negative. Results: 152 of 1,456 (10.4%) neonates became colonized. The mean time to acquire MRSA colonization was 17.1 ± 40.7 (range 1–471) days. The median time to decolonization was 36 days. About 20% of decolonized patients had been colonized for a prolonged period of ≧160 days. 47.5% of colonized patients were sent home colonized, and none with prolonged carriage developed MRSA-related infections in the following 6 months in contrast to 6 infants (3.9%) who developed MRSA sepsis during hospitalization. The only risk factor associated with prolonged carriage was the concurrent colonization of both the inguinal and nasal areas on admission. Conclusion:Nearly all neonates with acquired colonization became decolonized either prior to or after discharge from NICU. A significant percentage failed to decolonize prior to hospital discharge, but almost all decolonized by 30 months in the community without evidence of systemic or local infections.

show abstract

“…Epidemics of MRSA infection have been associated with understaffing, overcrowding, improper cleaning of equipment and hands, and mixing of patients in the NICU (13,182). Successful eradication of MRSA outbreaks has been accomplished by scrupulous attention to infection control measures as well as by intranasal mupiricin treatment of colonized patients and health care workers (22,184,202). Hexacholoraphene hand washing has also been used to control an MRSA outbreak in a NICU (383).…”

Section: Gram-positive Organismsmentioning

confidence: 99%

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

2004

View full text Add to dashboard Cite

Twenty percent of very-low-birth-weight (<1500 g) preterm infants experience a serious systemic infection, and despite advances in neonatal intensive care and antimicrobials, mortality is as much as threefold higher for these infants who develop sepsis than their counterparts without sepsis during their hospitalization. Outcomes may be improved by preventative strategies, earlier and accurate diagnosis, and adjunct therapies to combat infection and protect the vulnerable preterm infant during an infection. Earlier diagnosis on the basis of factors such as abnormal heart rate characteristics may offer the ability to initiate treatment prior to the onset of clinical symptoms. Molecular and adjunctive diagnostics may also aid in diagnosing invasive infection when clinical symptoms indicate infection but no organisms are isolated in culture. Due to the high morbidity and mortality, preventative and adjunctive therapies are needed. Prophylaxis has been effective in preventing early-onset group B streptococcal sepsis and late-onset Candida sepsis. Future research in prophylaxis using active and passive immunization strategies offers prevention without the risk of resistance to antimicrobials. Identification of the differences in neonatal intensive care units with low and high infection rates and implementation of infection control measures remain paramount in each neonatal intensive care unit caring for preterm infants

show abstract

Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment

Cited by 67 publications

References 17 publications

Sustained reductions in neonatal nosocomial infection rates following a comprehensive infection control intervention

Sustained reductions in neonatal nosocomial infection rates following a comprehensive infection control intervention

Clinical Outcomes in Methicillin-Resistant <i>Staphylococcus aureus-</i>Colonized Neonates in the Neonatal Intensive Care Unit

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

Contact Info

Product

Resources

About