Skip to main content Accessibility help
×
Home

Epidemiology of Methicillin-Susceptible Staphylococcus aureus in a Neonatology Ward

  • Yvonne Achermann (a1), Kati Seidl (a1), Stefan P. Kuster (a1), Nadja Leimer (a1), Nina Durisch (a1), Evelyne Ajdler-Schäffler (a1), Stephan Karrer (a1), Gabriela Senn (a1), Anne Holzmann-Bürgel (a1), Aline Wolfensberger (a1), Antonio Leone (a2), Romaine Arlettaz (a2), Annelies S. Zinkernagel (a1) and Hugo Sax (a1)...

Abstract

OBJECTIVE

In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward.

DESIGN

Multimodal outbreak investigation

SETTING

A public 800-bed tertiary care university hospital in Switzerland

METHODS

Investigations in 2012–2013, triggered by a MSSA infection cluster, included prospective MSSA infection surveillance, microbiologic screening of neonates and environment, onsite observations, and a prospective cohort study. MSSA isolates were characterized by pulsed-field gel electrophoresis (PFGE) and selected isolates were examined for multilocus sequence type (MLST) and virulence factors.

RESULTS

Among 726 in 2012, 30 (4.1%) patients suffered from MSSA infections including 8 (1.1%) with bacteremia. Among 655 admissions in 2013, 13 (2.0%) suffered from MSSA infections including 2 (0.3%) with bacteremia. Among 177 neonates screened for S. aureus carriage, overall 77 (44%) tested positive. A predominant PFGE-1-ST30 strain was identified in 6 of 30 infected neonates (20%) and 30 of 77 colonized neonates (39%). This persistent clone was pvl-negative, tst-positive and belonged to agr group III. We found no environmental point source. MSSA carriage was associated with central vascular catheter use but not with a particular midwife, nurse, physician, or isolette. Observed healthcare worker behavior may have propagated transmission via hands and fomites. Despite multimodal interventions, clonal transmission and colonization continued and another clone, PFGE-6-ST5, became predominant.

CONCLUSIONS

Hospital-acquired MSSA clones represent a high proportion of MSSA colonization but not MSSA infections in neonate inpatients. In contrast to persisting MSSA, transmission infection rates decreased concurrently with interventions. It remains to be established whether eradication of hospital-acquired MSSA strains would reduce infection rates further.

Infect. Control Hosp. Epidemiol. 2015;36(11):1305–1312

Copyright

Corresponding author

Address correspondence to Hugo Sax, MD, University Hospital of Zurich, University of Zurich, Division of Infectious Diseases and Hospital Epidemiology, Raemistrasse 100, CH-8091 Zurich, Switzerland (hugo.sax@usz.ch).

Footnotes

Hide All
a

Authors with equal contribution.

b

Authors with equal contribution.

PREVIOUS PRESENTATION: Parts of this study were presented as an oral presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, California, USA, September 17–23, 2012.

Footnotes

References

Hide All
1. Sax, H, Posfay-Barbe, K, Harbarth, S, et al. Control of a cluster of community-associated, methicillin-resistant Staphylococcus aureus in neonatology. J Hosp Infect 2006;63:93100.
2. Graham, PL 3rd, Morel, AS, Zhou, J, et al. Epidemiology of methicillin-susceptible Staphylococcus aureus in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2002;23:677682.
3. Carey, AJ, Duchon, J, Della-Latta, P, Saiman, L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000-2007. J Perinatol 2010;30:135139.
4. Wang, JL, Chen, SY, Wang, JT, et al. Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus . Clin Infect Dis 2008;46:799806.
5. Giuffre, M, Cipolla, D, Bonura, C, et al. Epidemic spread of ST1-MRSA-IVa in a neonatal intensive care unit, Italy. BMC Pediatr 2012;12:64.
6. Weidenmaier, C, Goerke, C, Wolz, C. Staphylococcus aureus determinants for nasal colonization. Trends Microbiol 2012;20:243250.
7. Rana, D, Abughali, N, Kumar, D, Super, DM, Jacobs, MR, Kumar, ML. Staphylococcus aureus, including community-acquired methicillin-resistant S. aureus, in a level III NICU: 2001 to 2008. Am J Perinatol 2012;29:401408.
8. Datta, F, Erb, T, Heininger, U, et al. A multicenter, cross-sectional study on the prevalence and risk factors for nasal colonization with Staphylococcus aureus in patients admitted to children's hospitals in Switzerland. Clin Infect Dis 2008;47:923926.
9. Jimenez-Truque, N, Tedeschi, S, Saye, EJ, et al. Relationship between maternal and neonatal Staphylococcus aureus colonization. Pediatrics 2012;129:e1252e1259.
10. Pinter, DM, Mandel, J, Hulten, KG, Minkoff, H, Tosi, MF. Maternal-infant perinatal transmission of methicillin-resistant and methicillin-sensitive Staphylococcus aureus . Am J Perinatol 2009;26:145151.
11. Frank, DN, Feazel, LM, Bessesen, MT, Price, CS, Janoff, EN, Pace, NR. The human nasal microbiota and Staphylococcus aureus carriage. PLoS One 2010;5:e10598.
12. Ruimy, R, Angebault, C, Djossou, F, et al. Are host genetics the predominant determinant of persistent nasal Staphylococcus aureus carriage in humans? J Infect Dis 2010;202:924934.
13. Cope, A, Shooter, RA, Green, SM, Noble, WC. Nasal carriage of Staphylococcus aureus by newborn babies. Br Med J 1961;2:329330.
14. Von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001;344:1116.
15. Wertheim, HF, Vos, MC, Ott, A, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004;364:703705.
16. Sax, H, Allegranzi, B, Chraiti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827834.
17. Sax, H, Allegranzi, B, Uckay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:921.
18. Chung, M, de, LH, Matthews, P, et al. Molecular typing of methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis: comparison of results obtained in a multilaboratory effort using identical protocols and MRSA strains. Microb Drug Resist 2000;6:189198.
19. Barnett, R, Larson, G. A phenol-chloroform protocol for extracting DNA from ancient samples. Methods Mol Biol 2012;840:1319.
20. Jarraud, S, Mougel, C, Thioulouse, J, et al. Relationships between Staphylococcus aureus genetic background, virulence factors, agr groups (alleles), and human disease. Infect Immun 2002;70:631641.
21. Lina, G, Piemont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:11281132.
22. Labandeira-Rey, M, Couzon, F, Boisset, S, et al. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science 2007;315:11301133.
23. Enright, MC, Day, NP, Davies, CE, Peacock, SJ, Spratt, BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus . J Clin Microbiol 2000;38:10081015.
24. Oelberg, DG, Joyner, SE, Jiang, X, Laborde, D, Islam, MP, Pickering, LK. Detection of pathogen transmission in neonatal nurseries using DNA markers as surrogate indicators. Pediatrics 2000;105:311315.
25. Leshem, E, Maayan-Metzger, A, Rahav, G, et al. Transmission of Staphylococcus aureus from mothers to newborns. Pediatr Infect Dis J 2012;31:360363.
26. Beard-Pegler, MA, Stubbs, E, Vickery, AM. Observations on the resistance to drying of staphylococcal strains. J Med Microbiol 1988;26:251255.
27. Desai, R, Pannaraj, PS, Agopian, J, Sugar, CA, Liu, GY, Miller, LG. Survival and transmission of community-associated methicillin-resistant Staphylococcus aureus from fomites. Am J Infect Control 2011;39:219225.
28. Conceicao, T, Aires de Sousa, M, Miragaia, M, et al. Staphylococcus aureus reservoirs and transmission routes in a Portuguese Neonatal Intensive Care Unit: a 30-month surveillance study. Microb Drug Resist 2012;18:116124.
29. Bertin, ML, Vinski, J, Schmitt, S, et al. Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 2006;27:581585.
30. Gomez-Gonzalez, C, Alba, C, Otero, JR, Sanz, F, Chaves, F. Long persistence of methicillin-susceptible strains of Staphylococcus aureus causing sepsis in a neonatal intensive care unit. J Clin Microbiol 2007;45:23012304.
31. Kim, YH, Chang, SS, Kim, YS, et al. Clinical outcomes in methicillin-resistant Staphylococcus aureus-colonized neonates in the neonatal intensive care unit. Neonatology 2007;91:241247.
32. Lepelletier, D, Corvec, S, Caillon, J, Reynaud, A, Roze, JC, Gras-Leguen, C. Eradication of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: which measures for which success? Am J Infect Control 2009;37:195200.
33. Delaney, HM, Wang, E, Melish, M. Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates. J Perinatol 2013;33:313318.
34. Lepainteur, M, Royer, G, Bourrel, AS, et al. Prevalence of resistance to antiseptics and mupirocin among invasive coagulase-negative staphylococci from very preterm neonates in NICU: the creeping threat? J Hosp Infect 2013;83:333336.
35. Allegranzi, B, Pittet, D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73:305315.
36. Robinson, DA, Kearns, AM, Holmes, A, et al. Re-emergence of early pandemic Staphylococcus aureus as a community-acquired meticillin-resistant clone. Lancet 2005;365:12561258.
37. Grundmann, H, Aanensen, DM, van den Wijngaard, CC, Spratt, BG, Harmsen, D, Friedrich, AW. Geographic distribution of Staphylococcus aureus causing invasive infections in Europe: a molecular-epidemiological analysis. PLoS Med 2010;7:e1000215.
38. Rolo, J, Miragaia, M, Turlej-Rogacka, A, et al. High genetic diversity among community-associated Staphylococcus aureus in Europe: results from a multicenter study. PLoS One 2012;7:e34768.
39. Megevand, C, Gervaix, A, Heininger, U, et al. Molecular epidemiology of the nasal colonization by methicillin-susceptible Staphylococcus aureus in Swiss children. Clin Microbiol Infect 2010;16:14141420.
40. Romano-Bertrand, S, Filleron, A, Mesnage, R, et al. Staphylococcus aureus in a neonatal care center: methicillin-susceptible strains should be a main concern. Antimicrob Resist Infect Control 2014;3:21.
Type Description Title
UNKNOWN
Supplementary materials

Achermann supplementary material S1
Supplementary Figure

 Unknown (2.2 MB)
2.2 MB
UNKNOWN
Supplementary materials

Achermann supplementary material S2
Supplementary Figure

 Unknown (818 KB)
818 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed