Management of outbreaks of nosocomial pathogens in Neonatal Intensive Care Unit

Abstract

Outbreaks of nosocomial pathogens are one of the most relevant problems in Neonatal Intensive Care Unit (NICU). Many factors contribute to the onset of an epidemic, including virulence of the pathogen and vulnerability of the infants hospitalized in NICU. Outbreaks are often caused by multidrug-resistant organisms (MDROs). MDROs are defined as microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. MDROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and certain gram-negative bacilli (GNB), have important infection control implications. Once MDROs are introduced into a healthcare setting, transmission and persistence of the resistant strain is determined by the availability of vulnerable patients, selective pressure exerted by antimicrobial use, increased potential for transmission from larger numbers of infected or colonized patients ("colonization pressure"), and the impact of adherence to prevention efforts. Often, routine infection control measures are not enough to contain outbreaks, and additional control measures are needed, including implementation of hand hygiene, cohorting of infected/colonized infants, neonatal surveillance cultures, screening of healthcare workers and decolonization of neonates and/or healthcare workers in selected cases. In this review, we report the practices we developed in our NICU to contain an epidemic. These recommendations reflect the experience of the group, as well as the findings of the current literature.

High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit

“…For all Staphylococcus isolates the median time for patient colonization ranged from 4 to 7 days, reflecting a rapid colonization by these microorganisms in the study NICU. According to Ghirardi and coworkers, once multiresistant organisms are introduced into a healthcare setting, some aspects that allow their transmission and persistence are the availability of vulnerable patients, antimicrobials selective pressure and the potential of intra hospital transmission [27]. We identified staphylococcal clones that persisted in the NICU of this study.…”

Healthcare Associated Infections of Methicillin-Resistant Staphylococcus aureus: A Case-Control-Control Study

“…Methicillin-resistant Staphylococcus aureus (MRSA) has spread throughout the world and has become one of the most frequent bacteria among healthcare-associated infections since it was first identified in 1961 [ 1 – 3 ]. MRSA can cause a number of life-threatening infections, such as septic shock, endocarditis, and severe pneumonia [ 4 ].…”