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American Academy of Pediatrics
Article

Methicillin-Resistant and Susceptible Staphylococcus aureus Bacteremia and Meningitis in Preterm Infants

Andi L. Shane, Nellie I. Hansen, Barbara J. Stoll, Edward F. Bell, Pablo J. Sánchez, Seetha Shankaran, Abbot R. Laptook, Abhik Das, Michele C. Walsh, Ellen C. Hale, Nancy S. Newman, Stephanie J. Schrag, Rosemary D. Higgins and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Pediatrics April 2012, 129 (4) e914-e922; DOI: https://doi.org/10.1542/peds.2011-0966
Andi L. Shane
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Nellie I. Hansen
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Barbara J. Stoll
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Edward F. Bell
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Pablo J. Sánchez
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Seetha Shankaran
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Abbot R. Laptook
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Abhik Das
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Michele C. Walsh
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Ellen C. Hale
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Nancy S. Newman
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Stephanie J. Schrag
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Rosemary D. Higgins
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Abstract

BACKGROUND: Data are limited on the impact of methicillin-resistant Staphylococcus aureus (MRSA) on morbidity and mortality among very low birth weight (VLBW) infants with S aureus (SA) bacteremia and/or meningitis (B/M).

METHODS: Neonatal data for VLBW infants (birth weight 401–1500 g) born January 1, 2006, to December 31, 2008, who received care at centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were collected prospectively. Early-onset (≤72 hours after birth) and late-onset (>72 hours) infections were defined by blood or cerebrospinal fluid cultures and antibiotic treatment of ≥5 days (or death <5 days with intent to treat). Outcomes were compared for infants with MRSA versus methicillin-susceptible S aureus (MSSA) B/M.

RESULTS: Of 8444 infants who survived >3 days, 316 (3.7%) had SA B/M. Eighty-eight had MRSA (1% of all infants, 28% of infants with SA); 228 had MSSA (2.7% of all infants, 72% of infants with SA). No infant had both MRSA and MSSA B/M. Ninety-nine percent of MRSA infections were late-onset. The percent of infants with MRSA varied by center (P < .001) with 9 of 20 centers reporting no cases. Need for mechanical ventilation, diagnosis of respiratory distress syndrome, necrotizing enterocolitis, and other morbidities did not differ between infants with MRSA and MSSA. Mortality was high with both MRSA (23 of 88, 26%) and MSSA (55 of 228, 24%).

CONCLUSIONS: Few VLBW infants had SA B/M. The 1% with MRSA had morbidity and mortality rates similar to infants with MSSA. Practices should provide equal focus on prevention and management of both MRSA and MSSA infections among VLBW infants.

KEY WORDS
  • Staphylococcus aureus
  • methicillin resistant
  • infant
  • newborn
  • Abbreviations:
    B/M —
    bacteremia and/or meningitis
    BPD —
    bronchopulmonary dysplasia
    BW —
    birth weight
    CI —
    confidence interval
    CSF —
    cerebrospinal fluid
    GA —
    gestational age
    IVH —
    intraventricular hemorrhage
    MRSA —
    methicillin-resistant Staphylococcus aureus
    MSSA —
    methicillin-susceptible Staphylococcus aureus
    NEC —
    necrotizing enterocolitis
    NICHD —
    Eunice Kennedy Shriver National Institute of Child Health and Human Development
    NRN —
    Neonatal Research Network
    PMA —
    postmenstrual age
    PVL —
    periventricular leukomalacia
    RDS —
    respiratory distress syndrome
    ROP —
    retinopathy of prematurity
    RR —
    relative risk
    SA —
    Staphylococcus aureus
    SGA —
    small for gestational age
    VLBW —
    very low birth weight
    • Accepted December 1, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 4
    1 Apr 2012
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    Methicillin-Resistant and Susceptible Staphylococcus aureus Bacteremia and Meningitis in Preterm Infants
    Andi L. Shane, Nellie I. Hansen, Barbara J. Stoll, Edward F. Bell, Pablo J. Sánchez, Seetha Shankaran, Abbot R. Laptook, Abhik Das, Michele C. Walsh, Ellen C. Hale, Nancy S. Newman, Stephanie J. Schrag, Rosemary D. Higgins, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
    Pediatrics Apr 2012, 129 (4) e914-e922; DOI: 10.1542/peds.2011-0966

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    Methicillin-Resistant and Susceptible Staphylococcus aureus Bacteremia and Meningitis in Preterm Infants
    Andi L. Shane, Nellie I. Hansen, Barbara J. Stoll, Edward F. Bell, Pablo J. Sánchez, Seetha Shankaran, Abbot R. Laptook, Abhik Das, Michele C. Walsh, Ellen C. Hale, Nancy S. Newman, Stephanie J. Schrag, Rosemary D. Higgins, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
    Pediatrics Apr 2012, 129 (4) e914-e922; DOI: 10.1542/peds.2011-0966
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