Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 469-474 (doi:10.1542/peds.2006-0254)
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ARTICLE

Methicillin-Resistant Staphylococcus aureus Colonization and Its Association With Infection Among Infants Hospitalized in Neonatal Intensive Care Units

Yhu-Chering Huang, MD, PhDa,b, Yi-Hong Chou, MDb,c, Lin-Hui Su, MSb,d, Rey-In Lien, MDb,c and Tzou-Yien Lin, MDa,b

a Divisions of Pediatric Infectious Diseases
c Neonatology, Chang Gung Children’s Hospital, Kweishan, Taoyuan, Taiwan
b School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
d Department of Clinical Pathology, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan

OBJECTIVES. We conducted this study to assess the rate of methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in methicillin-resistant S aureus–endemic NICUs.

METHODS. Between March 2003 and February 2004, surveillance culture specimens from the nares, postauricular areas, axillae, and umbilicus of infants admitted to the NICUs at a children’s hospital in Taiwan were obtained weekly for the detection of methicillin-resistant S aureus. All colonized and clinical isolates from each study infant with methicillin-resistant S aureus infection were genotyped with pulsed-field gel electrophoresis, with Sma1 digestion, and compared.

RESULTS. A total of 783 infants were included in this study. Methicillin-resistant S aureus colonization was detected for 323 infants during their NICU stays, with detection with the first 2 samples for 89%. Nares and umbilicus were the 2 most common sites of initial colonization. Methicillin-resistant S aureus colonization was associated significantly with premature birth (≤28 weeks) and low birth weight (≤1500 g), and infants with colonization had a significantly higher rate of methicillin-resistant S aureus infection, compared with those without colonization (26% vs 2%). Methicillin-resistant S aureus colonization was noted for 84 of 92 infants with methicillin-resistant S aureus infections. Of the 68 episodes with previous colonization and isolates available for genotyping analysis, colonized and clinical isolates were indistinguishable in 63 episodes, highly related in 2 episodes, and distinct in 3 episodes.

CONCLUSIONS. More than 40% of the hospitalized infants were colonized with methicillin-resistant S aureus during their stay in methicillin-resistant S aureus–endemic NICUs; this was associated significantly with methicillin-resistant S aureus infection. Most infants with methicillin-resistant S aureus infections had previous colonization with an indistinguishable strain.

Key Words: methicillin-resistant Staphylococcus aureus • colonization • infection • genotyping analysis • neonatal intensive care unit

Abbreviations: MRSA—methicillin-resistant Staphylococcus aureus • HCW—health care worker • PFGE—pulsed-field gel electrophoresis • MLST—multilocus sequence typing • OR—odds ratio • CI—confidence interval

Accepted Mar 6, 2006.




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