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Control of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive-Care Unit: Use of Intensive Microbiologic Surveillance and Mupirocin
Published online by Cambridge University Press: 02 January 2015
Abstract
Objective:
To describe the epidemiology and the inter ventions used to control two methicillin-resistant Staphylococcus aureus (MRSA) epidemics involving 46 infants with two fatalities in a neonatal intensive care unit (NICU).
Setting:
A 50-bed, level III NICU in a university hospital.
Interventions:
After traditional interventions failed to stop the first epidemic, an intensive microbiologic surveillance (IMS) program was developed. Cultures were obtained on all infants each week, and those colonized with MRSA were isolated. When an infant was found to be colonized with MRSA, cultures immediately were obtained on all surrounding infants. This was continued until no MRSA-colonized infants were found in the area. During the first epidemic, mupirocin was used in an attempt to eradicate the organism from the unit.
Results:
All infants, colonized and noncolonized, and parents of and personnel working with colonized infants were treated simultaneously with 5 days of mupirocin. This failed to eradicate MRSA in colonized infants. The spread of MRSA ceased in the unit, but a second epidemic occurred 4 months later. This time, IMS alone was successful in quickly containing the epidemic, and MRSA disappeared from the unit after all colonized infants were discharged. Plasmid analysis demonstrated that the same strain was responsible for both outbreaks.
Conclusions:
IMS and isolation are effective in containing the spread of MRSA in an NICU. The use of mupirocin failed to eradicate the organism.
- Type
- Original Articles
- Information
- Copyright
- Copyright © The Society for Healthcare Epidemiology of America 1996
References
1.Price, EH, Brain, A, Dickson, JA. Outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect 1980;1:221–228.Google Scholar
2.Graham, DR, Corre-Villasenor, A, Anderson, RL, Vollmon, JH, Baine, WB. Epidemic neonatal gentamicin-methicillin-resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin. J Pediatr 1980;97:972–977.CrossRefGoogle ScholarPubMed
3.Dunkle, LM, Naqvi, SH, McCallum, R, Lofgren, JP. Eradication of epidemic methicillin-gentamicin resistant Staphylococcus aureus in an intensive care nursery. Am J Med 1981;70:455–458.CrossRefGoogle Scholar
4.Gilbert, GL, Asche, V, Hewstone, AS, Mathieson, JL. Methicillinresistant Staphylococcus aureus in neonatal nurseries. Two years experience in special care nurseries in Melbourne. Med J Aust 1982;1:455–459.CrossRefGoogle ScholarPubMed
5.Hill, SF, Ferguson, D. Multiply-resistant Staphylococcus aureus (Bacteriophage type 90) in a special care baby unit. J Hosp Infect 1984;5:56–62.CrossRefGoogle Scholar
6.Lejeune, B, Buzit-Losquin, F, Simitzis-Le Flohic, AM, LeBras, MP, Alix, D. Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus in an intensive care unit for children. J Hosp Infect 1986;7:21–25.Google Scholar
7.Davies, EA, Emmerson, AM, Hogg, GM, Patterson, MF, Shields, MD. An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit. Value of topical mupirocin and of traditional methods of infection control. J Hosp Infect 1987;10:120–128.Google Scholar
8.Millar, MR, Keyworth, N, Lincoln, C, King, B, Congdon, P. Methicillin-resistant Staphylococcus aureus in a regional neonatology unit. J Hosp Infect 1987;10:187–197.CrossRefGoogle Scholar
9.Reboli, AC, Lenkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child 1989;143:34–39.Google Scholar
10.Farrington, M, Ling, J, Ling, T, French, GL. Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burn units of a new hospital. Epidemiol Infect 1990;105:215–228.Google Scholar
11.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 4th ed. Villanova, PA: National Committee for Clinical Laboratory Standards; 1990; Approved standard M2-A4.Google Scholar
12.Birnboim, HC, Doly, J. A rapid alkaline extraction procedure for screening recombinant plasmid DNA. Nucleic Acids Res 1979;7:1513–1523.CrossRefGoogle ScholarPubMed
13.Ish-Horowicz, D, Burke, JF. Rapid and efficient cosmid cloning. Nucleic Acids Res 1981;9:2989–2998.CrossRefGoogle ScholarPubMed
14.Larson, E. Guidelines for use of topical antimicrobial agents. Am J Infect Control 1988;16:253–266.Google Scholar
15.Williams, RE. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev 1963;27:56–71.Google Scholar
16.Rimland, D, Roberson, B. Gastrointestinal carriage of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1986;24:137–138.CrossRefGoogle ScholarPubMed
17.Linnemann, CC, Mason, M, Moore, P, Korfhagen, TR, Staneck, JL. Methicillin-resistant Staphylococcus aureus: experience in a general hospital over four years. Am J Epidemiol 1982;115(6):941–950.Google Scholar
18.Linnemann, CC, Moore, P, Staneck, JL, Pfaller, MA. Reemergence of epidemic methicillin-resistant Staphylococcus aureus in a general hospital associated with changing staphylococcal strains. Am J Med 1991;91(3B):238S–244S.CrossRefGoogle Scholar
19.Doebbeling, BN, Breneman, DL, Neu, HC, et al. Elimination of Staphylococcus aureus nasal carriage in health care workers: analyses of six clinical trials with calcium mupirocin ointment. Clin Infect Dis 1993;17:466–474.Google Scholar