Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T18:16:14.520Z Has data issue: false hasContentIssue false
  • English
  • Français

Active Surveillance Cultures and Decolonization to Reduce Staphylococcus aureus Infections in the Neonatal Intensive Care Unit

Published online by Cambridge University Press:  04 January 2016

Victor O. Popoola ,
Elizabeth Colantuoni ,
Nuntra Suwantarat ,
Rebecca Pierce ,
Karen C. Carroll ,
Susan W. Aucott  and
Aaron M. Milstone
Victor O. Popoola
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Elizabeth Colantuoni
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Nuntra Suwantarat
Affiliation:
Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Rebecca Pierce
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Susan W. Aucott
Affiliation:
Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Aaron M. Milstone*
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
*
Address correspondence to Aaron M. Milstone, MD, MHS, Johns Hopkins Department of Pediatric Infectious Diseases, 200 N Wolfe St/Rubenstein 3141, Baltimore, MD 21287 (amilsto1@jhmi.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Staphylococcus aureus is a common cause of healthcare-associated infections in neonates.

OBJECTIVE

To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance.

METHODS

We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network’s healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models.

RESULTS

Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19–0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74–0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10–0.79]). No mupirocin resistance was detected.

CONCLUSION

Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.

Infect. Control Hosp. Epidemiol. 2016;37(4):381–387

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 381 - 387
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Chu, A, Hageman, JR, Schreiber, M, Alexander, K. Antimicrobial therapy and late onset sepsis. NeoReviews 2012;13:e94–e102.Google Scholar
2. Stoll, BJ, Hansen, N, Fanaroff, AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.Google Scholar
3. Shane, AL, Hansen, NI, Stoll, BJ, et al. Methicillin-resistant and susceptible Staphylococcus aureus bacteremia and meningitis in preterm infants. Pediatrics 2012;129:e914–e922.Google Scholar
4. Popoola, VO, Budd, A, Wittig, SM, et al. MRSA transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization—challenges for infection prevention. Infect Control Hosp Epidemiol 2014;35:412–418.Google Scholar
5. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.Google Scholar
6. Payne, NR, Carpenter, JH, Badger, GJ, Horbar, JD, Rogowski, J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics 2004;114:348–355.CrossRefGoogle ScholarPubMed
7. Sohn, AH, Garrett, DO, Sinkowitz-Cochran, RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821–827.Google Scholar
8. Stoll, BJ, Hansen, NI, Adams-Chapman, I, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357–2365.Google Scholar
9. Schlapbach, LJ, Aebischer, M, Adams, M, et al. Impact of sepsis on neurodevelopmental outcome in a Swiss national cohort of extremely premature infants. Pediatrics 2011;128:e348–e357.Google Scholar
10. Hornik, CP, Fort, P, Clark, RH, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev 2012;88:S69–S74.Google Scholar
11. Hocevar, SN, Edwards, JR, Horan, TC, Morrell, GC, Iwamoto, M, Lessa, FC. Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol 2012;33:1200–1206.Google Scholar
12. Huang, YC, Lien, RI, Su, LH, Chou, YH, Lin, TY. Successful control of methicillin-resistant Staphylococcus aureus in endemic neonatal intensive care units—a 7-year campaign. PLoS One 2011;6:e23001.Google Scholar
13. Nelson, MU, Bizzarro, MJ, Baltimore, RS, Dembry, LM, Gallagher, PG. Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in the decade following implementation of an active detection and isolation program. J Clin Microbiol 2015;53:2492–2501.Google Scholar
14. Gerber, SI, Jones, RC, Scott, MV, et al. Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006;27:139–145.Google Scholar
15. Popoola, VO, Milstone, AM. Decolonization to prevent Staphylococcus aureus transmission and infections in the neonatal intensive care unit. J Perinatol 2014;34:805–810.Google Scholar
16. 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;30:135–139.Google Scholar
17. Kuint, J, Barzilai, A, Regev-Yochay, G, Rubinstein, E, Keller, N, Maayan-Metzger, A. Comparison of community-acquired methicillin-resistant Staphylococcus aureus bacteremia to other staphylococcal species in a neonatal intensive care unit. Eur J Pediatr 2007;166:319–325.Google Scholar
18. 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;23:677–682.Google Scholar
19. Ericson, JE, Popoola, VO, Smith, PB, et al. Burden of invasive Staphylococcus aureus infections in hospitalized infants [published online October 19, 2015]. JAMA Pediatr 2015:1–8.Google Scholar
20. Milstone, AM, Budd, A, Shepard, JW, et al. Role of decolonization in a comprehensive strategy to reduce methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit: an observational cohort study. Infect Control Hosp Epidemiol 2010;31:558–560.Google Scholar
21. Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN). Surveillance definitions for specific types of infections. CDC website. http://www.cdc.gov/nhsn/pdfs/validation/2013/2013-psc-manual-validate.pdf. Published 2013. Accessed November 7, 2013.Google Scholar
22. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 24th informational supplement. CLSI document. Wayne, PA: CLSI, 2014:M100–S24.Google Scholar
23. Suwantarat, N, Carroll, KC, Tekle, T, Ross, T, Popoola, VO, Milstone, AM. Low prevalence of mupirocin resistance among hospital-acquired methicillin-resistant Staphylococcus aureus isolates in a neonatal intensive care unit with an active surveillance cultures and decolonization program. Infect Control Hosp Epidemiol 2015;36:232–234.CrossRefGoogle Scholar
24. Linden, A. itsa: Stata module for conducting interrupted time series analysis for single and multiple groups. Linden Consulting website. http://lindenconsulting.org/stats.html. Published 2014.Google Scholar
25. Khoury, J, Jones, M, Grim, A, Dunne, WM Jr, Fraser, V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26:616–621.CrossRefGoogle ScholarPubMed
26. Calfee, DP, Salgado, CD, Milstone, AM, et al. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:S108–S132.Google Scholar
27. Nelson, MU, Bizzarro, MJ, Dembry, LM, Baltimore, RS, Gallagher, PG. One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units. J Perinatol 2014;34:653–655.Google Scholar
28. 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;33:313–318.CrossRefGoogle ScholarPubMed
29. Hitomi, S, Kubota, M, Mori, N, et al. Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment. J Hosp Infect 2000;46:123–129.Google Scholar
30. Walker, ES, Vasquez, JE, Dula, R, Bullock, H, Sarubbi, FA. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus: does mupirocin remain effective? Infect Control Hosp Epidemiol 2003;24:342–346.Google Scholar
31. Miller, MA, Dascal, A, Portnoy, J, Mendelson, J. Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996;17:811–813.Google Scholar
32. Jones, JC, Rogers, TJ, Brookmeyer, P, et al. Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 2007;45:541–547.Google Scholar
33. Choudhury, S, Krishnan, PU, Ang, B. Prevalence of high-level mupirocin resistance among meticillin-resistant Staphylococcus aureus isolates in a tertiary care hospital in Singapore. J Hosp Infect 2012;82:56–57.CrossRefGoogle Scholar
34. You, JH, Chan, CY, Wong, MY, Ip, M. Active surveillance and decolonization of methicillin-resistant Staphylococcus aureus on admission to neonatal intensive care units in Hong Kong: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2012;33:1024–1030.Google Scholar
35. Carey, AJ. War on Staphylococcus aureus . J Perinatol 2014;34:803–804.Google Scholar
36. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.Google Scholar