Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. 1039-1046 (doi:10.1542/10.1542/peds.2007-3161)
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ARTICLE

Emergence of and Risk Factors for Methicillin-Resistant Staphylococcus aureus of Community Origin in Intensive Care Nurseries

Ulrich Seybold, MD, MSCRa,b,c, J. Sue Halvosa, MScc, Nancy White, RNc, Victoria Voris, RN, MPHc, Susan M. Ray, MDb,c and Henry M. Blumberg, MDb,c

a Medizinische Poliklinik, Ludwig Maximilians University, Munich, Germany
b Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
c Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia

OBJECTIVE. The goal of this study was to define more clearly the impact of community-acquired methicillin-resistant Staphylococcus aureus clones (eg, USA300 and USA400) on colonization and infection in infants in intensive care nurseries and potential modes of transmission of community-acquired methicillin-resistant S aureus clones.

METHODS. Prospective surveillance for methicillin-resistant S aureus colonization and infection was performed among infants in the intensive care nurseries at Grady Memorial Hospital (Atlanta, GA) between 1993 and 2006. Beginning in September 2004, nares surveillance cultures were collected at admission. Methicillin-resistant S aureus isolates were genotyped by using pulsed-field gel electrophoresis and multiplex polymerase chain reaction assays for staphylococcal chromosomal cassette mec gene complex type and Panton-Valentine leukocidin genes. Prevalence of and risk factors for colonization with community-acquired versus health care-associated methicillin-resistant S aureus clones (eg, USA100) were assessed.

RESULTS. Between 1993 and 2006, 130 (3.5%) of 3707 infants were identified to be colonized with methicillin-resistant S aureus. Twelve (1.2%) of 996 admission nares cultures were positive for methicillin-resistant S aureus (since initiation of admission cultures in September 2004). Community-acquired methicillin-resistant S aureus clones were first recovered in 1998; the proportion of methicillin-resistant S aureus clones of community origin increased significantly between 1998 and 2004. Multivariate analysis identified vaginal delivery and maternal smoking, both among infants of mothers receiving systemic antibiotic treatment before delivery, as independent predictors for neonatal colonization with community-acquired methicillin-resistant S aureus. Systemic antibiotic therapy before delivery for nonsmoking mothers delivering through cesarean section and possibly endotracheal intubation were associated with the recovery of health care-associated methicillin-resistant S aureus clones.

CONCLUSIONS. Community-acquired methicillin-resistant S aureus clones have emerged as a major cause of methicillin-resistant S aureus colonization in high-risk newborns. Community-acquired methicillin-resistant S aureus recovery was associated with acquisition during birth, whereas health care-associated methicillin-resistant S aureus clones seemed to be transmitted nosocomially.

Key Words: Staphylococcus aureus • methicillin resistance • pulsed-field gel electrophoresis • colonization • NICU

Abbreviations: MRSA—methicillin-resistant Staphylococcus aureus • CA—community-associated • ICN—intensive care nursery • HA—health care-associated • PFGE—pulsed-field gel electrophoresis • SCCmec—staphylococcal chromosomal cassette mec gene complex • PVL—Panton-Valentine leukocidin • OR—odds ratio • CI—confidence interval • CDC—Centers for Disease Control and Prevention • PFT—pulsed-field type • aOR—adjusted odds ratio

Accepted Feb 25, 2008.


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