Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e790-e796 (doi:10.1542/peds.2008-1526)
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ARTICLE

Seven-Year Experience With a Surveillance Program to Reduce Methicillin-Resistant Staphylococcus aureus Colonization in a Neonatal Intensive Care Unit

Mary Lucia Gregory, MD, MMSca,b,c, Eric C. Eichenwald, MDd,e and Karen M. Puopolo, MD, PhDb,c,f,g

a Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
b Division of Newborn Medicine, Children's Hospital, Boston, Massachusetts
c Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
d Section of Neonatology, Texas Children's Hospital, Houston, Texas
e Department of Pediatrics, Baylor College of Medicine, Houston, Texas
f Channing Laboratory
g Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts

OBJECTIVES. The objectives of this study were to determine the incidence rates of neonatal methicillin-resistant Staphylococcus aureus colonization and infection after the implementation of a NICU methicillin-resistant S aureus surveillance and isolation program and to describe the characteristics of infants with methicillin-resistant S aureus colonization and invasive disease.

METHODS. From August 2000 through August 2007, all infants admitted to the study NICU were screened for methicillin-resistant S aureus colonization with weekly nasal/rectal swabs; colonized or infected infants were isolated and cared for as a cohort. The annual incidence rates of methicillin-resistant S aureus colonization and infection were monitored, and characteristics of methicillin-resistant S aureus-colonized and -infected infants were compared. Data were collected from infant, maternal, and hospital laboratory records.

RESULTS. During the study period, 7997 infants were admitted to the NICU and 102 methicillin-resistant S aureus-colonized or -infected infants (1.3%) were identified. The incidence of methicillin-resistant S aureus decreased progressively from 1.79 cases per 1000 patient-days in 2000 to 0.15 cases per 1000 patient-days in 2005, but the incidence then increased to 1.26 cases per 1000 patient-days in 2007. Fifteen of the 102 case infants (14.7%) had invasive infections; no significant differences between infected and colonized infants were identified. Methicillin-resistant S aureus isolates with 14 different antibiograms were found during the study period. There was a shift from isolates predominantly likely to be hospital-associated in 2000–2004 to those likely to be community-associated in 2006–2007.

CONCLUSIONS. A continuous program of weekly methicillin-resistant S aureus surveillance cultures and isolation of affected infants was associated with a variable incidence of methicillin-resistant S aureus colonization over a 7-year study period. Methicillin-resistant S aureus was not eradicated from this tertiary-care NICU, and our data suggest that infants were colonized by multiple different methicillin-resistant S aureus strains during the study period.

Key Words: infant • newborn • NICU • Staphylococcus aureus • methicillin resistance • infection control

Abbreviations: CA—community-associated • HA—hospital-associated • MRSA—methicillin-resistant Staphylococcus aureus • CI—confidence interval

Accepted Jan 13, 2009.


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