Results of Nasal Screening for Methicillin-ResistantStaphylococcus aureusduring a Neonatal Intensive Care Unit Outbreak

Abstract

Recent reports have implicated community-associated methicillin-resistant Staphylococcus aureus (MRSA) as a cause of outbreaks in the neonatal intensive care unit (NICU). This study was conducted to determine whether community-associated MRSA caused such an outbreak in our NICU and the extent of nasal colonization with MRSA among exposed babies and health care workers. MRSA recovered from infected and colonized babies were genotyped by pulse-field gel electrophoresis (PFGE). Infection control measures were intensified and included nasal screening for MRSA colonization of exposed babies and all new admissions to the NICU within 24 hours of delivery. PFGE type A was recovered from five infected infants and colonized 81% of the exposed infants. The colonization rate during the outbreak was 9.3% and was 1.9% during admission screening. No MRSA infection occurred during 12 months while admission screening was implemented. Hospital-associated MRSA was the dominant strain in this outbreak. Higher colonization rates occurred during the outbreak period.

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

“…[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] The studies provided screening data on 19 722 neonatal and pediatric patients. More specifically, 11 studies reported data on 12 284 screened neonates in 12 NICUs, whereas 6 studies reported data on 7107 children hospitalized in 6 PICUs.…”

“…33 In studies that reported data stratified by year or ICU setting, data sets were split to discrete strata and considered separately. 24,28,34,35,38 The majority of the included studies (11 of 18) were prospective, and the remaining 7 were retrospective.…”

“…Seven of 18 studies (4 that included NICU patients and 3 that included PICU patients) 24,[26][27][28][29]31,35 followed the patients until their discharge, transfer to another facility, or death and provided data on the development of MRSA infections. The data of each individual study are summarized in Table 3.…”

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

“…Hierzu gehört zum Beispiel auch die Rolle des Eintrages von MRGN in die NICU durch besiedelte Eltern [71]. Der von der KRIN-KO bewusst eingeschlagene Weg einer proaktiven Eindämmung der nosokomialen Übertragung aufgrund von Ergebnissen des wöchentlichen Kolonisationsscreenings [12] [12,14,72]. Hierfür ist eine sorgfältige und systematische Beschreibung der beobachteten Ereignisse (am besten im Rahmen prospektiver multizentrischer Studien innerhalb der vorhandenen Netzwerke) von großer Bedeutung.…”

Literatur-Update zu Staphylococcus-aureus-Ausbrüchen auf neonatologischen Intensivpflegestationen (2010–2013)

“…Carey et al [16] Mongkolrattanothai et al [18] MSSA und MRSA Ja MLVF Murillo et al [19] MRSA Ja PFGE Schlebusch et al [20] MRSA (caMRSA, PVL-positiv, nicht multiresistent) Ja MALDI-TOF, SNP-plus-binary gene typing Song et al [21] MRSA (haMRSA und caMRSA) Ja Rep-PCR Heinrich et al [14] haMRSA (Rhein-Hessen Stamm) Ja PFGE, Phagentypisierung Ali et al [22] MRSA (vorherrschender Ausbruchsstamm: South West Pacific (SWP) Klon, PVL-positiv) Ja PFGE, spa-Typisierung, MLST, MLVA Giuffrè et al [23] MRSA (ST1-MRSA-IVa) Ja MLST, MLVA Köser et al [24] MRSA Ja Gesamtgenomsequenzierung Nübel et al [25] MRSA Ja Gesamtgenomsequenzierung Pinto et al [30] MRSA (PVL-positiv, ST22-MRSA-IV) Ja PFGE, spa-Typisierung, MLST, RLB binary typing Scheithauer et al [15] MRSA Ja PFGE, spa-Typisierung Brennan et al [28] MRSA (PVL-positiv, ST772-MRSA-V) Ja PFGE, DNA microarray profiling und spa-Typisierung, MLST Bei Brennan et al [28] waren 2 Pflegekräfte und 1 Kind (einer Pflegekraft) besiedelt. Eine Pflegekraft, die kürzlich nach Indien gereist war und dort stationär behandelt wurde (Geburt eines Kindes), wurde als "Indexfall" identifiziert.…”