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Mahieu L, Engelen A, Hensels E, Van Damme K, Matheeussen V. Surveillance on meticillin-sensitive Staphylococcus aureus colonization and infection in a neonatal intensive care unit. J Hosp Infect 2024; 143:195-202. [PMID: 37858807 DOI: 10.1016/j.jhin.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Meticillin-sensitive Staphylococcus aureus (MSSA) infection is a significant health concern in neonatal intensive care units (NICUs). Bacterial colonization increases the risk of subsequent infection, leading to morbidity and mortality. AIM To report the findings of a retrospective cohort study on the surveillance of MSSA colonization and infection in NICU patients. METHODS The weekly microbial surveillance results for MSSA colonization in the throat, nose, anus, and groin, as well as invasive and non-invasive MSSA infections, were analysed from November 2020 to June 2022. The MSSA infection and colonization risk were compared after adjustment for confounders by stepwise logistic regression analysis. FINDINGS Three hundred and eighty-three neonates were screened; 42.8% (N=164) were MSSA colonized. Significant risk factors for MSSA colonization were length of stay, vaginal delivery and extreme low gestational age <28 weeks (ELGAN) (all P<0.05). The surveillance detected 38 (9.9%) mild MSSA infections and 11 (2.9%) invasive MSSA infections. Neonatal colonization with MSSA is a major risk factor for MSSA infection overall (29.3% in colonized/infected vs 70.7% colonized/not-infected and 0.5% in not-colonized/infected vs 99.5% in not-colonized/not-infected infants) and invasive MSSA infections (6.1% in colonized/infected vs 93.9% in colonized/not-infected and 0.5% in non-colonized/infected vs 99.5% not-colonized/not-infected infants). Also, extreme low birth weight (<1000 g), ELGAN and invasive ventilation were significant risk factors for MSSA infections (all, P<0.05). CONCLUSIONS The link between postnatal MSSA colonization and subsequent MSSA infection offers possibilities for prevention. Additional research is needed to explore the association between vaginal birth and the pathogenesis of neonatal MSSA colonization.
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Affiliation(s)
- L Mahieu
- Department of Neonatal Intensive Care, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - A Engelen
- Department of Neonatal Intensive Care, Antwerp University Hospital, Edegem, Belgium
| | - E Hensels
- Department of Neonatal Intensive Care, Antwerp University Hospital, Edegem, Belgium
| | - K Van Damme
- Department of Neonatal Intensive Care, Antwerp University Hospital, Edegem, Belgium
| | - V Matheeussen
- Department of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium
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2
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Aneja A, Johnson J, Prochaska EC, Milstone AM. Microbiome dysbiosis: a modifiable state and target to prevent Staphylococcus aureus infections and other diseases in neonates. J Perinatol 2024; 44:125-130. [PMID: 37904005 PMCID: PMC10842217 DOI: 10.1038/s41372-023-01810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023]
Abstract
Bacterial infections present a significant threat to neonates. Increasingly, studies demonstrate associations between human diseases and the microbiota, the communities of microorganisms on or in the body. A "healthy" microbiota with a great diversity and balance of microorganisms can resist harmful pathogens and protect against infections, whereas a microbiota suffering from dysbiosis, can predispose to pathogen colonization and subsequent infection. For decades, strategies such as bacterial interference, decolonization, prebiotics, and probiotics have been tested to reduce Staphylococcus aureus disease and other infections in neonates. More recently, microbiota transplant has emerged as a strategy to broadly correct dysbiosis, promote colonization resistance, and prevent infections. This paper discusses the benefits of a healthy neonate's microbiota, exposures that alter the microbiota, associations of dysbiosis and neonatal disease, strategies to prevent dysbiosis, such as microbiota transplantation, and presents a framework of microbiome manipulation to reduce Staphylococcus aureus (S. aureus) and other infections in neonates.
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Affiliation(s)
- Anushree Aneja
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Johnson
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica C Prochaska
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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3
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Popovich KJ, Aureden K, Ham DC, Harris AD, Hessels AJ, Huang SS, Maragakis LL, Milstone AM, Moody J, Yokoe D, Calfee DP. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:1039-1067. [PMID: 37381690 PMCID: PMC10369222 DOI: 10.1017/ice.2023.102] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Kyle J. Popovich
- Department of Internal Medicine, RUSH Medical College, Chicago, Illinois
| | - Kathy Aureden
- Infection Prevention, Advocate Aurora Health, Downers Grove, Illinois
| | - D. Cal Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anthony D. Harris
- Health Care Outcomes Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amanda J. Hessels
- Columbia School of Nursing, New York, New York
- Hackensack Meridian Health, Edison, New Jersey
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Moody
- Infection Prevention, HCA Healthcare, Nashville, Tennessee
| | - Deborah Yokoe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
- Transplant Infectious Diseases, UCSF Medical Center, San Francisco, California
| | - David P. Calfee
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Okomo UA, Darboe S, Bah SY, Ayorinde A, Jarju S, Sesay AK, Kebbeh N, Gai A, Dibbasey T, Grey-Johnson M, Le Doare K, Holt KE, Lawn JE, Kampmann B. Maternal colonization and early-onset neonatal bacterial sepsis in the Gambia, West Africa: a genomic analysis of vertical transmission. Clin Microbiol Infect 2023; 29:386.e1-386.e9. [PMID: 36243352 DOI: 10.1016/j.cmi.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To define bacterial aetiology of neonatal sepsis and estimate the prevalence of neonatal infection from maternal genital tract bacterial carriage among mother-newborn pairs. METHODS We carried out a cross-sectional study of newborns with clinical sepsis admitted to three hospitals in the Gambia neonatal wards. Neonatal blood cultures and maternal genital swabs were obtained at recruitment. We used whole-genome sequencing to explore vertical transmission for neonates with microbiologically confirmed bloodstream infection by comparing phenotypically-matched paired neonatal blood cultures and maternal genital tract bacterial isolates. RESULTS We enrolled 203 maternal-newborn pairs. Two-thirds (67%; 137/203) of neonates presented with early-onset sepsis (days 0-6 after birth) of which 26% (36/137) were because of a clinically-significant bacterial pathogen. Blood culture isolates from newborns with early-onset sepsis because of Staphylococcus aureus (n = 5), Klebsiella pneumonia (n = 2), and Enterococcus faecalis (n = 1), phenotypically matched their maternal genital tract isolates. Pairwise single-nucleotide variants comparisons showed differences of 12 to 52 single-nucleotide variants only between maternal and newborn S. aureus isolates, presumably representing vertical transmission with a transmission rate of 14% (5/36). CONCLUSIONS We found a low prevalence of vertical transmission of maternal genital tract colonization in maternal-newborn pairs for early-onset neonatal sepsis in the West African context. Identifying infection acquisition pathways among newborns is essential to prioritize preventive interventions, which could be targeted at the mother or infection control in the hospital environment, depending on the major pathways of transmission.
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Affiliation(s)
- Uduak A Okomo
- Vaccines and Immunity Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia; MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Saffiatou Darboe
- Disease Control and Elimination Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Saikou Y Bah
- Vaccines and Immunity Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia; Florey Institute for Host-Pathogen Interactions, University of Sheffield, Sheffield, United Kingdom
| | - Abigail Ayorinde
- Vaccines and Immunity Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Sheikh Jarju
- Vaccines and Immunity Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Abdul Karim Sesay
- Vaccines and Immunity Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Ngange Kebbeh
- Disease Control and Elimination Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Abdou Gai
- Department of Paediatrics, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Tida Dibbasey
- Department of Paediatrics, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Mary Grey-Johnson
- Department of Paediatrics, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Kirsty Le Doare
- Institute of Infection and Immunity, St George's University of London, Cranmer Terrace, London, United Kingdom
| | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, Gambia; The Vaccine Centre, and Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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5
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Reducing Staphylococcus aureus infections in the neonatal intensive care unit. J Perinatol 2022; 42:1540-1545. [PMID: 35487977 DOI: 10.1038/s41372-022-01407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/07/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our neonatal intensive care unit (NICU) saw an increase in Staphylococcus aureus (SA) infections-methicillin-resistant SA (MRSA) infections increased from 2.1/10,000 patient days (PD) to 5.1/10,000 PD, and methicillin-sensitive SA (MSSA) infections from 1.2/10,000 PD to 3.9/10,000 PD. This quality improvement project aimed to decrease the rates of SA infections to less than 2.0/10,000 PD, and to determine the rate of SA decolonization. METHODS Infection prevention interventions targeted patient factors (SA surveillance, patient cohorting, decolonization protocol), provider factors (provider cohorting, enhanced hand hygiene) and environmental factors (room structure, equipment optimization). RESULTS The rates of MRSA and MSSA infections decreased to 0.6/10,000 PD and 0.7 infections/10,000 PD respectively. Persistent decolonization of SA was successful in 67% of colonized patients. CONCLUSIONS Specific interventions targeting patient, provider, and environmental factors, including the implementation of a SA decolonization protocol, were successful in decreasing the incidence of SA infections in neonates.
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6
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Sultan N, Shchors I, Assous MV, Bar-Meir M. The NICU flora: An effective technique to sample surfaces. PLoS One 2021; 16:e0257821. [PMID: 34555096 PMCID: PMC8460043 DOI: 10.1371/journal.pone.0257821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Environmental surface sampling in healthcare settings is not routinely recommended. There are several methods for environmental surface sampling, however the yield of these methods is not well defined. The aim of the present study is to compare two methods of environmental surface sampling, to characterize the neonatal intensive care unit (NICU) flora, compare it with rates of infection and colonization and correlate it with the workload. Design and setting First, the yield of the swab and the gauze-pad methods were compared. Then, longitudinal surveillance of environmental surface sampling was performed over 6 months,once weekly, from pre-specified locations in the NICU. Samples were streaked onto selective media and bacterial colonies were identified using matrix-assisted laser desorption-ionization time-of-flight (MALDI-TOF). Results The number of colonies isolated using the gauze pad method was significantly higher compared with the swab method. Overall, 87 bacterial species of 30 different bacterial genera were identified on the NICU environmental surfaces. Of these, 18% species were potential pathogens, and the other represent skin and environmental flora. In 20% of clinical cultures and in 60% of colonization cultures, the pathogen was isolated from the infant’s environment as well. The number of bacteria in environmental cultures was negatively correlated with nurse/patient ratio in the day prior to the culture. Conclusion The gauze pad method for environmental sampling is robust and readily available. The NICU flora is very diverse and is closely related with the infants’ flora, therefore it may serve as a reservoir for potential pathogens.
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Affiliation(s)
- Naomi Sultan
- Pediatric Department, Shaare-Zedek Medical Center, Jerusalem, IL, United States of America
| | - Irina Shchors
- Neonatal Intensive Care Unit, Shaare-Zedek Medical Center, Jerusalem, IL, United States of America
| | - Marc V. Assous
- Microbiology Laboratory, Shaare-Zedek Medical Center, Jerusalem, IL, United States of America
- Faculty of Medicine, The Hebrew University, Jerusalem, IL, United States of America
| | - Maskit Bar-Meir
- Faculty of Medicine, The Hebrew University, Jerusalem, IL, United States of America
- Infectious Diseases, Shaare-Zedek Medical Center, Jerusalem, IL, United States of America
- * E-mail:
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Nurjadi D, Eichel VM, Tabatabai P, Klein S, Last K, Mutters NT, Pöschl J, Zanger P, Heeg K, Boutin S. Surveillance for Colonization, Transmission, and Infection With Methicillin-Susceptible Staphylococcus aureus in a Neonatal Intensive Care Unit. JAMA Netw Open 2021; 4:e2124938. [PMID: 34515783 PMCID: PMC8438598 DOI: 10.1001/jamanetworkopen.2021.24938] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Staphylococcus aureus is one of the leading causes of infections in neonatal intensive care units (NICUs). Most studies in this patient group focus on methicillin-resistant S aureus or the outbreak setting, whereas data for methicillin-susceptible S aureus are limited. OBJECTIVES To identify risk factors for S aureus colonization and infections in hospitalized newborns and to investigate S aureus transmission and its dynamics in a nonoutbreak setting. DESIGN, SETTING, AND PARTICIPANTS This monocentric cohort study in a tertiary NICU in Heidelberg, Germany, enrolled all hospitalized neonates (n = 590) with at least 1 nasal screening swab positive for S aureus. Data were collected from January 1, 2018, to December 31, 2019. EXPOSURES Weekly screening for S aureus colonization was performed for all newborns until discharge. MAIN OUTCOMES AND MEASURES The primary end point was any S aureus infection until hospital discharge. Transmission of S aureus and performance of routine typing to detect transmissions were defined as the secondary outcomes of the study. RESULTS In total, 590 newborns were enrolled (276 [46.8%] female and 314 [53.2%] male; 220 [37.3%] with birthweight <1500 g; 477 [80.8%] preterm; 449 [76.1%] singletons; 419 [71.5%] delivered via cesarean section). The median length of stay was 26 (range, 10-62) days. Overall, 135 infants (22.9%) were colonized by S aureus at some time during their hospital stay. The median time to first detection was 17 (interquartile range, 11-37) days. The overall incidence of S aureus infection was 1.7% (10 of 590). Low birth weight (<1500 g [odds ratio, 9.3; 95% CI, 5.9-14.6; P < .001]) and longer hospital stay (odds ratio, 2.3; 95% CI, 1.9-2.7; P < .001) were associated with colonization. Nasal carriage was significantly associated with S aureus infection (odds ratio, 8.2; 95% CI, 2.1-32.3; P = .002). A total of 123 of 135 colonization isolates were sequenced. All recoverable infection isolates (4 of 7) of newborns with colonization were genetically identical to the colonizing isolate. Whole-genome sequencing indicated 23 potential transmission clusters. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that nasal colonization is a relevant risk factor for S aureus infection in a nonoutbreak NICU setting. In colonized newborns, infection and colonization isolates were genetically identical, suggesting that eradication of colonization may be a useful measure to prevent infection. Further investigations are necessary to validate and assess the generalizability of our findings.
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Affiliation(s)
- Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Vanessa M. Eichel
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrik Tabatabai
- Department of Neonatology, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Last
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Nico T. Mutters
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Johannes Pöschl
- Department of Neonatology, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Philipp Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Sébastien Boutin
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
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Wang H, Salamon D, Jean S, Leber AL. Evaluation of the Cepheid Xpert SA Nasal Complete for direct detection of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in nasal swabs from pediatric patients. Diagn Microbiol Infect Dis 2021; 101:115417. [PMID: 34116341 DOI: 10.1016/j.diagmicrobio.2021.115417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Abstract
Nasal carriers of Staphylococcus aureus (SA) are at increased risk for health-care associated infections with this organism. Timely detection of SA and Methicillin-resistant SA (MRSA) and subsequent decolonization are important components of infection control. While performance of nucleic acid amplification-based tests for detection of SA/MRSA in adults has been well-described, limited data are available in children. Our objective was to evaluate the performance of the Xpert SA in pediatric patients. Overall, for detection of SA, Xpert SA demonstrated a sensitivity and specificity of 95.1% and 93.5%, respectively and 87.8% sensitive and 98.1% specific for detection of MRSA. Performance in different age groups was similar but neonates had the lowest sensitivity and highest invalid rates. The Xpert SA is a rapid, reliable test to detect MSSA and MRSA nasal colonization in pediatric patients. Depending on the potential clinical impact, culture may be considered as a companion test to improve sensitivity.
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Affiliation(s)
- Huanyu Wang
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital; Department of Pathology, The Ohio State University, Columbus, OH
| | - Doug Salamon
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital
| | - Sophonie Jean
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital; Department of Pathology, The Ohio State University, Columbus, OH
| | - Amy L Leber
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital; Department of Pathology, The Ohio State University, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH.
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Molecular epidemiology of methicillin-susceptible Staphylococcus aureus in infants in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2020; 41:1402-1408. [PMID: 32935655 DOI: 10.1017/ice.2020.355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the molecular epidemiology of methicillin-susceptible Staphylococcus aureus (MSSA) in infants in a neonatal intensive care unit (NICU) using whole-genome sequencing. DESIGN Investigation of MSSA epidemiology in a NICU. SETTING Single-center, level IV NICU. METHODS Universal S. aureus screening was done using a single swab obtained from the anterior nares, axilla, and groin area of infants in the NICU on a weekly basis. Core genome multilocus sequence type (cgMLST) analysis was performed on MSSA isolates detected over 1 year (2018-2019). RESULTS In total, 68 MSSA-colonized infants were identified, and cgMLSTs of 67 MSSA isolates were analyzed. Overall, we identified 11 cgMLST isolate groups comprising 39 isolates (58%), with group sizes ranging from 2 to 10 isolates, and 28 isolates (42%) were unrelated to each other or any of the isolate groups. Cases of infants colonized by MSSA were scattered throughout the 1-year study period, and isolates belonging to the same cgMLST group were typically detected contemporaneously, over a few weeks or a few months. Overall, 13 infants (19.7%) developed MSSA infections: bacteremia (n = 3), wound infection (n = 5), conjunctivitis (n = 4), and cellulitis (n = 1). We detected no association between these clinically manifest infections and specific cgMLST groups. CONCLUSIONS Although MSSA isolates in infants in a NICU showed high diversity, most were related to other isolates, albeit within small groups. cgMLST facilitates an understanding of the complex transmission dynamics of MSSA in NICUs, and these data can be used to inform better control strategies.
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10
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Phenotypic screening for detection of methicillin-resistant Staphylococcus aureus in clinical settings. ASIAN BIOMED 2020. [DOI: 10.1515/abm-2019-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Chen YH, Huang KYA, Huang YC, Chi H, Lu CY, Chang LY, Ho YH, Chi CY, Liu CC, Huang LM, Yang TYO, Huang YC. Prevalence and molecular characterizations of Staphylococcus aureus nasal colonization among patients in pediatric intensive care units in Taiwan. Antimicrob Resist Infect Control 2020; 9:41. [PMID: 32106887 PMCID: PMC7045409 DOI: 10.1186/s13756-020-0700-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Nasal colonization of Staphylococcus aureus is a risk factor for the pathogen transmission and the development of infections. Limited information is available on the prevalence and molecular characteristics of S. aureus colonization in pediatric intensive care unit (ICU) patients. Methods A cross-sectional, island-wide study was conducted in 2011. Nasal swabs were collected from pediatric ICU patients at six tertiary hospitals in Taiwan. Results Of 114 patients enrolled in total, nasal colonization of S. arueus was detected in 30 (26.3%) of them, among whom 20 (17.5%) with methicillin-resistant S. arueus (MRSA). The ST59/SCCmec IV and V clones were most common and accounted for 45% of MRSA isolates, followed by ST239/SCCmec III (25%) and ST45/SCCmec IV (20%) clones. Three ST59 MRSA isolates carried the Panton-Valentine Leukocidin genes. Conclusions The results indicated a high prevalence of S. arueus and MRSA nasal colonization among pediatric ICU patients in Taiwan. Identification of epidemic clones warrants the implement of infection control measures to reduce colonization and prevent the dissemination of MRSA in hospitals.
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Affiliation(s)
- Yu-Hsin Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Ying A Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chuan Huang
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Division of Infectious Diseases, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin Chi
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chun-Yi Lu
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Huai Ho
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chia-Yu Chi
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan. .,Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan. .,Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
| | - Ching-Chuan Liu
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Li-Min Huang
- Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tien Yu Owen Yang
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Taiwan Pediatric Infectious Diseases Alliance, Taipei, Taiwan. .,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
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Rouard C, Bourgeois-Nicolaos N, Rahajamanana L, Romain O, Pouga L, Derouin V, De Luca D, Doucet-Populaire F. Evaluation of an 'all-in-one' seven-day whole-genome sequencing solution in the investigation of a Staphylococcus aureus outbreak in a neonatal intensive care unit. J Hosp Infect 2019; 102:297-303. [PMID: 30771369 DOI: 10.1016/j.jhin.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Meticillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA) are responsible for outbreaks in intensive care units. MSSA infections have the same morbidity and mortality rate as MRSA infections but are studied less often. Whole-genome sequencing (WGS) is used increasingly for outbreak monitoring, but still requires specific installation and trained personnel to obtain and analyse the data. AIM To evaluate the workflow and benefits of EpiSeq solution (bioMérieux, Marcy l'Etoile, France) in exploring the increased incidence of S. aureus bloodstream infections in a neonatal intensive care unit (NICU). METHODS Four S. aureus bacteraemia isolates and 27 colonization isolates obtained between January and July 2016 were submitted to the 'all in one solution' EpiSeq [WGS, quality data assessment, multi-locus sequence typing (MLST), spa typing, virulome and resistome characterization, and phylogenetic tree construction]. More in-depth analyses were performed (whole-genome MLST and whole-genome single nucleotide polymorphism (wgSNP)] with BioNumerics software (Applied Maths, Sint-Martens-Latem, Belgium). FINDINGS Nine different sequence types and 13 different spa types were found among the 31 isolates studied. Among those isolates, 11 (seven patients) were ST146 spa type t002, five (four patients) were ST30 and four (four patients) were ST398. The 11 ST146 isolates had a maximum of seven pairwise SNP differences. CONCLUSION Use of EpiSeq solution allowed fast demonstration of the polyclonal profile of the MSSA population in neonates, and enabled the suspicion of a global outbreak to be ruled out. However, wgSNP analysis showed the transmission and persistence of one sequence type for over six months in the NICU, and enabled the infection control team to adapt its response.
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Affiliation(s)
- C Rouard
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France; EA4043, Bactéries pathogènes et santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France
| | - N Bourgeois-Nicolaos
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France; EA4043, Bactéries pathogènes et santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Université Paris Sud, Paris Saclay University, Gif sur Yvette, France
| | - L Rahajamanana
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France
| | - O Romain
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Division of Paediatrics and Neonatal Intensive Care, Clamart, France
| | - L Pouga
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France
| | - V Derouin
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France
| | - D De Luca
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Division of Paediatrics and Neonatal Intensive Care, Clamart, France; INSERM-U999 LabEx - LERMIT, Clamart, France
| | - F Doucet-Populaire
- AP-HP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Service de Bactériologie-Hygiène, Clamart, France; EA4043, Bactéries pathogènes et santé, Faculté de Pharmacie, Université Paris Sud, Chatenay-Malabry, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Université Paris Sud, Paris Saclay University, Gif sur Yvette, France.
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Kotloff KL, Shirley DAT, Creech CB, Frey SE, Harrison CJ, Staat M, Anderson EJ, Dulkerian S, Thomsen IP, Al-Hosni M, Pahud BA, Bernstein DI, Yi J, Petrikin JE, Haberman B, Stephens K, Stephens I, Oler RE, Conrad TM. Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units. Pediatrics 2019; 143:peds.2018-1565. [PMID: 30587533 PMCID: PMC6317770 DOI: 10.1542/peds.2018-1565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5849573989001PEDS-VA_2018-1565Video Abstract BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of late-onset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants. METHODS Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed. RESULTS A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (P < .001). Twenty-one of 46 (45.7%) treated infants were persistently decolonized compared with 1 of 48 (2.1%) controls (P < .001). CONCLUSIONS Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized.
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Affiliation(s)
- Karen L. Kotloff
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | - Debbie-Ann T. Shirley
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | - C. Buddy Creech
- Vanderbilt Vaccine Research Program, Department of
Pediatrics, School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | | | - Mary Staat
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Evan J. Anderson
- Departments of Medicine and,Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | | | - Isaac P. Thomsen
- Vanderbilt Vaccine Research Program, Department of
Pediatrics, School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | | | - David I. Bernstein
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Jumi Yi
- Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | | | - Beth Haberman
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Kathy Stephens
- Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | - Ina Stephens
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
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Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU. Infect Control Hosp Epidemiol 2018; 39:1334-1339. [PMID: 30226122 DOI: 10.1017/ice.2018.223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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 designSingle-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.
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Khamash DF, Voskertchian A, Milstone AM. Manipulating the microbiome: evolution of a strategy to prevent S. aureus disease in children. J Perinatol 2018; 38:105-109. [PMID: 29120455 PMCID: PMC5790614 DOI: 10.1038/jp.2017.155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Abstract
Hospitalized infants have the highest rates of invasive Staphylococcus aureus disease of any population and infection control strategies such as decolonization have been insufficient. For decades, researchers began studying the microbiome in search of new prevention strategies. The resident microbiota was found to be closely associated with susceptibility and at times, resistance to S. aureus colonization. The evolution of nucleic acid based techniques has enhanced our understanding of the complex relationship between the nasal microbiota and S. aureus colonization. We review what is known about bacterial communities in the nasal cavity of infants and discuss how future microbiome studies may help identify novel interventions to protect high-risk infants from S. aureus disease.
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Affiliation(s)
- Dina F. Khamash
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Annie Voskertchian
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
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Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study. Infect Control Hosp Epidemiol 2017; 38:930-936. [PMID: 28578731 DOI: 10.1017/ice.2017.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To characterize the risk of infection after MRSA decolonization with intranasal mupirocin. DESIGN Multicenter, retrospective cohort study. SETTING Tertiary care neonatal intensive care units (NICUs) from 3 urban hospitals in the United States ranging in size from 45 to 100 beds. METHODS MRSA-colonized neonates were identified from NICU admissions occurring from January 2007 to December 2014, during which a targeted decolonization strategy was used for MRSA control. In 2 time-to-event analyses, MRSA-colonized neonates were observed from the date of the first MRSA-positive surveillance screen until (1) the first occurrence of novel gram-positive cocci in sterile culture or discharge or (2) the first occurrence of novel gram-negative bacilli in sterile culture or discharge. Mupirocin exposure was treated as time varying. RESULTS A total of 522 MRSA-colonized neonates were identified from 16,144 neonates admitted to site NICUs. Of the MRSA-colonized neonates, 384 (74%) received mupirocin. Average time from positive culture to mupirocin treatment was 3.5 days (standard deviation, 7.2 days). The adjusted hazard of gram-positive cocci infection was 64% lower among mupirocin-exposed versus mupirocin-unexposed neonates (hazard ratio, 0.36; 95% confidence interval [CI], 0.17-0.76), whereas the adjusted hazard ratio of gram-negative bacilli infection comparing mupirocin-exposed and -unexposed neonates was 1.05 (95% CI, 0.42-2.62). CONCLUSIONS In this multicentered cohort of MRSA-colonized neonates, mupirocin-based decolonization treatment appeared to decrease the risk of infection with select gram-positive organisms as intended, and the treatment was not significantly associated with risk of subsequent infections with organisms not covered by mupirocin's spectrum of activity. Infect Control Hosp Epidemiol 2017;38:930-936.
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Wisgrill L, Zizka J, Unterasinger L, Rittenschober-Böhm J, Waldhör T, Makristathis A, Berger A. Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible Staphylococcus aureus Infections in VLBW Infants. Neonatology 2017; 112:267-273. [PMID: 28704818 DOI: 10.1159/000477295] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/04/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Methicillin-susceptible Staphylococcus aureus (MSSA) is a major contributor to infectious episodes of very low birth weight infants (VLBWI), resulting in significant morbidity and mortality. OBJECTIVE To examine the efficacy and safety of surveillance cultures and the decolonization of MSSA-colonized VLBWI. METHODS VLBWI admitted to our neonatal wards in 2011-2016 were retrospectively analyzed. Rates of MSSA-attributable infections were compared before and after the implementation of active surveillance cultures and the decolonization of MSSA-colonized patients. The mupirocin susceptibility of isolated MSSA strains was routinely tested. RESULTS A total of 1,056 VLBWI were included in the study, 552 in the pre-intervention period and 504 in the post-intervention period. The implementation of surveillance cultures and decolonization of colonized patients resulted in a 50% reduction of incidence rates per 1,000 patient-days of MSSA-attributable infections (1.63 [95% CI 1.12-2.31] vs. 0.83 [95% CI 0.47-1.35], p = 0.024). No adverse effects were observed from application of the decolonization protocol with mupirocin and octenidin. No mupirocin-resistant MSSA strains were detected during the study period. CONCLUSION Implementation of an active surveillance and decolonization protocol resulted in a reduction of MSSA-attributable infections in VLBWI.
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Affiliation(s)
- Lukas Wisgrill
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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18
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Pierce R, Lessler J, Popoola VO, Milstone AM. Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme. J Hosp Infect 2016; 95:91-97. [PMID: 27887754 DOI: 10.1016/j.jhin.2016.10.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that drive MRSA transmission. AIM To measure the association between colonization pressure from decolonized and non-decolonized neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA. METHODS An eight-year retrospective cohort study was conducted in a level-4 NICU that used active surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (non-decolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of incident MRSA colonization associated with colonization pressure exposures. The population-attributable fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or untreated patients in this setting. FINDINGS Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6% increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01-1.11]. Risk of acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98-1.04). In the context of this MRSA control programme, 22% (95% CI: 4.0-37) of MRSA acquisition could be attributed to exposures to untreated MRSA carriers. CONCLUSION Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and require further investigation.
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Affiliation(s)
- R Pierce
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V O Popoola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MA, USA.
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Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes. Curr Opin Infect Dis 2016; 28:384-91. [PMID: 26098502 DOI: 10.1097/qco.0000000000000179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Healthcare-associated infections (HAIs) are a leading cause of adverse patient outcomes. Further elucidation of the etiology of these infections and the pathogens that cause them has been a primary goal of research in infection control and healthcare epidemiology. Longitudinal studies, in particular, afford a range of statistical methods to better understand the process of pathogen acquisition or HAI development. This review intends to convey the scope of available statistical methodology. RECENT FINDINGS Despite the range of methods available, logistic regression remains the dominant statistical approach in use. Poisson regression, survival methods, and mechanistic (mathematical) models remain underutilized. Recent studies that use these approaches are looking beyond associations to answer questions about the timing, duration, and mechanism of infectious risk. SUMMARY Logistic regression remains an important approach to the study of HAIs, but in the context of cohort studies, it is most appropriate for short observation periods, during which mechanism is not of primary interest. Additional statistical methodologies are available to build upon risk factor analysis to better inform the process of risk and infection in the hospital setting.
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Outbreak in newborns of methicillin-resistant Staphylococcus aureus related to the sequence type 5 Geraldine clone. Am J Infect Control 2016; 44:e9-11. [PMID: 26589999 DOI: 10.1016/j.ajic.2015.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 01/23/2023]
Abstract
We describe the first nosocomial outbreak of a toxic shock syndrome-positive methicillin-resistant Staphylococcus aureus (MRSA) sequence type 5 Geraldine clone. Infection control interventions that are usually successful were implemented to control the outbreak. Spread of this virulent MRSA strain highlights the need to be vigilant to MRSA antibiotic susceptibilities.
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Active Surveillance Cultures and Decolonization to Reduce Staphylococcus aureus Infections in the Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2016; 37:381-7. [PMID: 26725699 DOI: 10.1017/ice.2015.316] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Staphylococcus aureus is a common cause of healthcare-associated infections in neonates. OBJECTIVE To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. METHODS We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models. RESULTS Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected. CONCLUSION Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
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Ericson JE, Popoola VO, Smith PB, Benjamin DK, Fowler VG, Benjamin DK, Clark RH, Milstone AM. Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants. JAMA Pediatr 2015; 169:1105-11. [PMID: 26502073 PMCID: PMC4694042 DOI: 10.1001/jamapediatrics.2015.2380] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Staphylococcus aureus is a frequent cause of infection in hospitalized infants. These infections are associated with increased mortality and morbidity and longer hospital stays, but data on the burden of S aureus disease in hospitalized infants are limited. OBJECTIVES To compare demographics and mortality of infants with invasive methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA), to determine the annual proportion of S aureus infections that were MRSA, and to contrast the risk of death after an invasive MRSA infection with the risk after an invasive MSSA infection. DESIGN, SETTING, AND PARTICIPANTS Multicenter retrospective study of a large, nationally representative cohort at 348 neonatal intensive care units managed by the Pediatrix Medical Group. Participants were 3888 infants with an invasive S aureus infection who were discharged from calendar year 1997 through calendar year 2012. EXPOSURE Invasive S aureus infection. MAIN OUTCOMES AND MEASURES The incidence of invasive S aureus infections, as well as infant characteristics and mortality after MRSA or MSSA infection. RESULTS The 3888 infants had 3978 invasive S aureus infections (2868 MSSA and 1110 MRSA). The incidence of invasive S aureus infection was 44.8 infections per 10,000 infants. The yearly proportion of invasive infections caused by MRSA increased from calendar year 1997 through calendar year 2006 and has moderately decreased since then. Infants with invasive MRSA or MSSA infections had similar gestational ages and birth weights. Invasive MRSA infections occurred more often at a younger postnatal age. For infants with available mortality data, more infants with invasive MSSA infections (n = 237) died before hospital discharge than infants with invasive MRSA infections (n = 110). The proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2474 (9.6%) and 110 of 926 (11.9%), respectively (P = .05). The adjusted risk of death before hospital discharge was similar after invasive MSSA and MRSA infections (risk ratio, 1.19; 95% CI, 0.96-1.49). The risks of death at 7 and 30 days after invasive infection were similar between infants with invasive MSSA infection and infants with invasive MRSA infection. CONCLUSIONS AND RELEVANCE Infant mortality after invasive MRSA and MSSA infections is similar, but MSSA causes more infections and more deaths in infants than MRSA. Measures to prevent S aureus infection should include MSSA in addition to MRSA.
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Affiliation(s)
- Jessica E. Ericson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Victor O. Popoola
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - Vance G. Fowler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - Aaron M. Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
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Milstone AM, Koontz DW, Voskertchian A, Popoola VO, Harrelson K, Ross T, Aucott SW, Gilmore MM, Carroll KC, Colantuoni E. Treating Parents to Reduce NICU Transmission of Staphylococcus aureus (TREAT PARENTS) trial: protocol of a multisite randomised, double-blind, placebo-controlled trial. BMJ Open 2015; 5:e009274. [PMID: 26353875 PMCID: PMC4567681 DOI: 10.1136/bmjopen-2015-009274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION More than 33,000 healthcare-associated infections occur in neonatal intensive care units (NICUs) each year in the USA. Parents, rather than healthcare workers, may be a reservoir from which neonates acquire Staphylococcus aureus (S. aureus) colonisation in the NICU. This study looks to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonisation and infection in neonates. METHODS AND ANALYSIS The TREAT PARENTS trial (Treating Parents to Reduce Neonatal Transmission of S. aureus) is a multicentre randomised, masked, placebo-controlled trial. Shortly after a neonate is admitted to the NICU, parents will be tested for S. aureus colonisation. If either parent screens positive for S. aureus, then both parents as a pair will be enrolled and randomised to one of the two possible masked treatment arms. Arm 1 will include assignment to intranasal 2% mupirocin plus topical antisepsis with chlorhexidine gluconate impregnated cloths for 5 days. Arm 2 will include assignment to placebo ointment and placebo cloths for skin antisepsis for 5 days. The primary outcome will be neonatal acquisition of an S. aureus strain that is concordant to the parental baseline S. aureus strain as determined by periodic surveillance cultures or a culture collected during routine clinical care that grows S. aureus. Secondary outcomes will include neonatal acquisition of S. aureus, neonatal S. aureus infection, eradication of S. aureus colonisation in parents, natural history of S. aureus colonisation in parents receiving placebo, adverse reactions to treatment, feasibility of intervention, and attitudes and behaviour in consented parents. Four hundred neonate-parent pairs will be enrolled. ETHICS AND DISSEMINATION The study was approved by Johns Hopkins University IRB in June 2014 (IRB number 00092982). Protocol V.7 was approved in November 2014. Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02223520.
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Affiliation(s)
- Aaron M Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle W Koontz
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annie Voskertchian
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Victor O Popoola
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Harrelson
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tracy Ross
- Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Susan W Aucott
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maureen M Gilmore
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen C Carroll
- Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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25
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Guo P, Lam SL. Unusual structures of TTTA repeats in icaC gene of Staphylococcus aureus. FEBS Lett 2015; 589:1296-300. [PMID: 25935415 DOI: 10.1016/j.febslet.2015.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 11/25/2022]
Abstract
One and two TTTA repeat expansions have been found in the coding region of icaC gene of Staphylococcus aureus variants which influence the expression of IcaC protein and alter the phenotype. Yet, the mechanism of these small-size TTTA repeat expansions remains unclear. In this study, we performed high-resolution nuclear magnetic resonance spectroscopic studies on TTTA repeats. Our results show that a DNA sequence containing three TTTA repeats can fold into dumbbell structures with a 3' or 5'-overhang. Exchange of these dumbbells makes the sequence behave like a 2-nt TT mini-loop at 25°C. The occurrence of these mini-loop and dumbbell structures in the nascent strand during DNA replication provides possible mechanistic pathways which account for one and two repeat expansions.
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Affiliation(s)
- Pei Guo
- Department of Chemistry, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Sik Lok Lam
- Department of Chemistry, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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26
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Affiliation(s)
- A J Carey
- 1] Division of Neonatology, Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA, USA [2] Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
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