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Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU

Published online by Cambridge University Press:  18 September 2018

Ibukunoluwa C. Akinboyo Open the ORCID record for Ibukunoluwa C. Akinboyo [Opens in a new window] ,
Annie Voskertchian ,
Gezahegn Gorfu ,
Joshua F. Betz ,
Tracy L. Ross ,
Karen C. Carroll  and
Aaron M. Milstone
Ibukunoluwa C. Akinboyo*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins UniversitySchool of Medicine, Baltimore, Maryland
Annie Voskertchian
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins UniversitySchool of Medicine, Baltimore, Maryland
Gezahegn Gorfu
Affiliation:
Department of Clinical Laboratory Science, College of Nursing and Allied Health Sciences, Howard University, Washington, DC
Joshua F. Betz
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Tracy L. Ross
Affiliation:
Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
Aaron M. Milstone
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins UniversitySchool of Medicine, Baltimore, Maryland
*
Author for correspondence: Ibukunoluwa C. Akinboyo, 200 North Wolfe Street, Room 3150, Baltimore, MD 21287. E-mail: ibukun.a@duke.edu
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Abstract

Objectives

To examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.

Study design

Single-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.

Setting

Johns Hopkins Hospital’s 45-bed level IV NICU in Baltimore, Maryland.

Methods

Demographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.

Results

Of 2,060 infants screened for S. aureus, 271 (13%) were colonized, and 203 of these 271 (75%) received intranasal mupirocin. Of those treated, 162 (80%) had follow-up surveillance cultures, and 63 of these 162 infants (39%) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.19–5.90; and HR, 2.21; 95% CI, 1.02–4.75, respectively).

Conclusion

Strains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1334 - 1339
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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