Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Giuffrè, Mario; Amodio, Emanuele; Bonura, Celestino; Geraci, Daniela Maria; Saporito, Laura; Ortolano, Rita; Corsello, Giovanni; Mammina, Caterina

doi:10.1016/j.ajic.2014.12.027

Cited by 35 publications

(43 citation statements)

References 26 publications

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“…Approximately 1 out of 5 neonates colonized with MRSA may develop an infection [5, 6, 18, 19], corresponding to a relative risk of 24.2 (95% CI 8.9–66.0) compared to noncolonized neonates [16]. The median time between MRSA colonization and the onset of infection may range from 4 to 9 days [18, 20].…”

Section: Neonatal Mrsa Colonization and Infectionsmentioning

confidence: 99%

“…The incidence of MRSA infections in neonates with a BW ≤1,000 g has been reported to be 53.4 per 10,000 infants, compared to 23.2, 7.9, and 5.0 per 10,000 infants in the BW categories of 1,001–1,500, 1,501–2,500, and > 2,500 g, respectively [2]. Other risk factors for MRSA infections include prolonged hospitalization, overcrowding and understaffing in neonatal wards, long-term use of respiratory support, intravascular catheters, antibiotics, and total parenteral nutrition, as well as surgical procedures [6, 18, 19]. The clinical manifestation of MRSA infections may range from mild focal infections, such as conjunctivitis and skin and soft tissue infections, to more severe forms like toxic shock syndrome [24] and even invasive infections such as sepsis, necrotizing pneumonia, meningitis, endocarditis, osteomyelitis, liver abscesses, and urinary tract infections [2, 18, 23, 25-27].…”

Section: Neonatal Mrsa Colonization and Infectionsmentioning

confidence: 99%

“…The median time between MRSA colonization and the onset of infection may range from 4 to 9 days [18, 20]. Prematurity has been identified to be the principal risk factor for MRSA colonization and subsequent infections [2, 17, 19, 23]. The incidence of MRSA infections in neonates with a BW ≤1,000 g has been reported to be 53.4 per 10,000 infants, compared to 23.2, 7.9, and 5.0 per 10,000 infants in the BW categories of 1,001–1,500, 1,501–2,500, and > 2,500 g, respectively [2].…”

Section: Neonatal Mrsa Colonization and Infectionsmentioning

confidence: 99%

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New Threats from an Old Foe: Methicillin-Resistant Staphylococcus aureus Infections in Neonates

2018

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Methicillin-resistant Staphylococcus aureus (MRSA) is a ubiquitous human inhabitant and one of the important pathogens of neonatal infections. MRSA is associated with significant mortality and morbidity, especially in very immature preterm neonates. Moreover, MRSA may be implicated in adverse long-term neonatal outcomes, posing a substantial disease burden. Recent advances in molecular microbiology have shed light on the evolution of MRSA population structure and virulence factors, which may contribute to MRSA epidemic waves worldwide. Equipped with remarkable genetic flexibility, MRSA has successfully developed resistance to an extensive range of antibiotics including vancomycin, as well as antiseptics. In the face of these new challenges from MRSA, our armamentarium of anti-infective strategies is very limited and largely dependent on prevention measures. Active surveillance cultures followed by decolonization may be a promising approach to control MRSA infections, with its efficacy and safety in the specific population of neonates yet to be addressed by large multicenter studies.

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Section: Neonatal Mrsa Colonization and Infectionsmentioning

confidence: 99%

Section: Neonatal Mrsa Colonization and Infectionsmentioning

confidence: 99%

Section: Neonatal Mrsa Colonization and Infectionsmentioning

confidence: 99%

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New Threats from an Old Foe: Methicillin-Resistant Staphylococcus aureus Infections in Neonates

2018

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“…There is now widespread community-associated methicillin-resistant S. aureus (CA-MRSA), and infections can spread within households, day care centers, and schools (3). In addition, Giuffre et al observed an increasing incidence of MRSA in neonates (4). The ability of some strains of MRSA to revert to methicillin-susceptible isolates, particularly in skin and soft tissue infections, has been observed (5).…”

mentioning

confidence: 99%

Lack of Involvement of Fenton Chemistry in Death of Methicillin-Resistant and Methicillin-Sensitive Strains of Staphylococcus aureus and Destruction of Their Genomes on Wet or Dry Copper Alloy Surfaces

Warnes

Keevil

2016

Appl Environ Microbiol

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The pandemic of hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has declined, but the evolution of strains with enhanced virulence and toxins and the increase of community-associated infections are still a threat. In previous studies, 10 7 MRSA bacteria applied as simulated droplet contamination were killed on copper and brass surfaces within 90 min. However, contamination of surfaces is often via finger tips and dries rapidly, and it may be overlooked by cleaning regimes (unlike visible droplets). In this new study, a 5-log reduction of a hardy epidemic strain of MRSA (epidemic methicillin-resistant S. aureus 16 [EMRSA-16]) was observed following 10 min of contact with copper, and a 4-log reduction was observed on copper nickel and cartridge brass alloys in 15 min. A methicillin-sensitive S. aureus (MSSA) strain from an osteomyelitis patient was killed on copper surfaces in 15 min, and 4-log and 3-log reductions occurred within 20 min of contact with copper nickel and cartridge brass, respectively. Bacterial respiration was compromised on copper surfaces, and superoxide was generated as part of the killing mechanism. In addition, destruction of genomic DNA occurs on copper and brass surfaces, allaying concerns about horizontal gene transfer and copper resistance. Incorporation of copper alloy biocidal surfaces may help to reduce the spread of this dangerous pathogen. Intrinsic penicillin resistance and acquisition of resistance to methicillin in the 1980s by Staphylococcus aureus led to a pandemic of infections worldwide. Initially, the majority of infections were contracted in health care environments, but incorporation of measures to control the spread, including preadmission screening, decolonization, improved disinfection, and antibiotic treatment, have stemmed the tide (1). The increased use of antibiotics required for the epidemic of infections caused by Gram-positive pathogens has allowed the evolution of multidrug-resistant Gram-negative pathogens, effectively transforming some commensal gut bacteria into potential killers. However, new strains of S. aureus that have acquired further virulence factors and toxins or that have adapted to a specific environment, for example, an increased ability to cause bacteremia (2), are still a considerable threat. There is now widespread community-associated methicillin-resistant S. aureus (CA-MRSA), and infections can spread within households, day care centers, and schools (3). In addition, Giuffre et al. observed an increasing incidence of MRSA in neonates (4). The ability of some strains of MRSA to revert to methicillin-susceptible isolates, particularly in skin and soft tissue infections, has been observed (5).Colonization with MRSA increases the risk of MRSA infection, particularly following illness, surgical procedures, and treatment with immunosuppressive drugs. Colonization and/or infection may also occur from touching contaminated surfaces. In the community, a recent study observed that 58% and 82% of surfaces in 19 f...

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“…A similar approach is needed as with other dangerous colonizations, such as Meticillin Resistan Staphylococcus Aureus. (10,11) In fact, the combination of "nearly endemic" presence of Candida colonization in neonates with other risks factors, increases the risk of SFI. Prevention of candidemia in neonates is supported by identification and adequate management of specific risk factors, including low birth weight, use of invasive devices, prolonged hospitalization and use of broad-spectrum antimicrobial agents.…”

Section: Introductionmentioning

confidence: 99%

The burden of Candida species colonization in NICU patients: a colonization surveillance study

2017

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Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identification of specific risk factors supports prevention of candidemia in neonates. Effective prophylactic strategies have recently become available, but the identification and adequate management of high-risk infants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor incidence, species distribution, and antifungal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (10.17%) patients tested positive for Candida spp. (C.), at least on one occasion. All the colonized patients tested positive for the rectal swab, whereas 7 patients also tested positive for the nasal swab. Fifteen out of 472 patients (3.18%) had more than one positive rectal or nasal swab during their NICU stay. Moreover, 9 out of 15 patients tested negative at the first sampling, suggesting they acquired Candida spp. during their stay. Twenty-five of forty-eight (52.1%) colonized patients carried C.albicans and 15/48 (31.25%) C.parapsilosis. We identified as risk factors for Candida spp. colonization: antibiotic therapy, parenteral nutrition, the use of a central venous catheter, and nasogastric tube. Our experience suggests that effective microbiological surveillance can allow for implementing proper, effective and timely control measures in a highrisk setting.

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Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Cited by 35 publications

References 26 publications

New Threats from an Old Foe: Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> Infections in Neonates

New Threats from an Old Foe: Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> Infections in Neonates

Lack of Involvement of Fenton Chemistry in Death of Methicillin-Resistant and Methicillin-Sensitive Strains of Staphylococcus aureus and Destruction of Their Genomes on Wet or Dry Copper Alloy Surfaces

The burden of Candida species colonization in NICU patients: a colonization surveillance study

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