1
|
Keneh NK, Kenmoe S, Bowo-Ngandji A, Akoachere JFTK, Kamga HG, Ndip RN, Ebogo-Belobo JT, Kengne-Ndé C, Mbaga DS, Tendongfor N, Assam JPA, Ndip LM, Esemu SN. Methicillin-Resistant Staphylococcus aureus Carriage among Neonate Mothers, Healthcare Workers, and Environmental Samples in Neonatal Intensive Care Units: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2024; 2024:5675786. [PMID: 38623471 PMCID: PMC11018372 DOI: 10.1155/2024/5675786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/12/2023] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The MRSA colonization of neonates, attributed to various sources, including mothers, healthcare workers, and environmental surfaces, can lead to severe infection, prolonged hospital stays, and even death, imposing substantial economic burdens. Given the pressing need to mitigate MRSA spread in these vulnerable environments, further examination of the subject is warranted. This systematic review is aimed at synthesizing available evidence on MRSA carriage proportions among mothers of newborns, healthcare workers, and environmental surfaces in NICUs. Methodology. We included observational studies published in English or French from database inception to March 21, 2023. These studies focused on MRSA in nonoutbreak NICU settings, encompassing healthy neonate mothers and healthcare workers, and environmental surfaces. Literature search involved systematic scanning of databases, including Medline, Embase, Web of Science, Global Health, and Global Index Medicus. The quality of the selected studies was assessed using the Hoy et al. critical appraisal scale. The extracted data were summarized to calculate the pooled proportion of MRSA positives, with a 95% confidence interval (CI) based on the DerSimonian and Laird random-effects model. Results A total of 1891 articles were retrieved from which 16 studies were selected for inclusion. Most of the studies were from high-income countries. The pooled proportion of MRSA carriage among 821 neonate mothers across four countries was found to be 2.1% (95% CI: 0.3-5.1; I2 = 76.6%, 95% CI: 36.1-91.5). The proportion of MRSA carriage among 909 HCWs in eight countries was determined to be 9.5% (95% CI: 3.1-18.4; I2 = 91.7%, 95% CI: 87.1-94.6). The proportion of MRSA carriage among HCWs was highest in the Western Pacific Region, at 50.00% (95% CI: 23.71-76.29). In environmental specimens from five countries, a pooled proportion of 16.6% (95% CI: 3.5-36.0; I2 = 97.7%, 95% CI: 96.6-98.4) was found to be MRSA-positive. Conclusion With a significant heterogeneity, our systematic review found high MRSA carriage rates in neonate mothers, healthcare workers, and across various environmental surfaces in NICUs, posing a potential risk of nosocomial infections. Urgent interventions, including regular screening and decolonization of MRSA carriers, reinforcing infection control measures, and enhancing cleaning and disinfection procedures within NICUs, are crucial. This trial is registered with CRD42023407114.
Collapse
Affiliation(s)
- Nene Kaah Keneh
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | - Hortense Gonsu Kamga
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaoundé, Cameroon
| | - Roland Ndip Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | - Nicholas Tendongfor
- Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon
| | | | - Lucy Mande Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| |
Collapse
|
2
|
Southwick KL, Greenko J, Quinn MJ, Haley VB, Adams E, Lutterloh E. Methicillin-resistant Staphylococcus aureus (MRSA) clusters in neonatal intensive care units (NICUs) and other neonatal units in New York State (NYS), 2001 to 2017. Am J Infect Control 2024; 52:424-435. [PMID: 37778709 DOI: 10.1016/j.ajic.2023.09.015] [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: 07/02/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND New York State (NYS) mandates reporting of all hospital-associated communicable disease outbreaks. We describe trends in NYS surveillance for neonatal unit methicillin-resistant Staphylococcus aureus (MRSA) outbreaks, the evolution of national MRSA infection prevention and control (IPC) recommendations, and IPC measures taken by NYS neonatal units. METHODS We evaluated trends of reported neonatal unit MRSA outbreaks by etiology from 2001 to 2017. We reviewed all reports and the use of IPC recommendations over time. RESULTS From 2001 to 2017, 124 MRSA outbreaks were reported in 47 hospital neonatal units, with a total of 1,055 laboratory-confirmed infant cases, 18 infant deaths, and 52 laboratory-confirmed staff cases. The number of outbreaks increased with the level of care. During the study period, a higher proportion of hospitals reported implementing IPC measures, including reinforcing hand hygiene compliance (increased from 79.2% to 95.1%) and enhancing environmental cleaning and disinfection (increased from 4.2% to 78.0%) as well as performing active surveillance testing (AST) on exposed neonates (increased from 4.2% to 51.2%) and molecular testing on MRSA-positive isolates (increased from 5.3% to 18.9%). CONCLUSIONS From 2001 to 2017, IPC measures in neonatal units increased in parallel with expanded national IPC recommendations. However, MRSA outbreaks in neonatal units continued to be frequent occurrences in NYS.
Collapse
Affiliation(s)
- Karen L Southwick
- Healthcare Epidemiology and Infection Control Program, New York State Department of Health, New Rochelle, NY.
| | - Jane Greenko
- Healthcare Epidemiology and Infection Control Program, New York State Department of Health, Central Islip, NY
| | - Monica J Quinn
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, NY
| | - Valerie B Haley
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, NY; Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
| | - Eleanor Adams
- Healthcare Epidemiology and Infection Control Program, New York State Department of Health, New Rochelle, NY
| | - Emily Lutterloh
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, NY; Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
| |
Collapse
|
3
|
Wu X, Wang C, He L, Xu H, Jing C, Chen Y, Deng J, Lin A, Deng H, Cai H, Chen Y, Yang J, Zhang T, Cao Q, Hao J, Huang Y, Yu H. Clinical characteristics and antibiotic resistance profile of invasive MRSA infections in newborn inpatients: a retrospective multicenter study from China. BMC Pediatr 2023; 23:264. [PMID: 37231456 DOI: 10.1186/s12887-023-04084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) can cause invasive infections with significant mortality in neonates. This study aimed to analyze the clinical characteristics and antibiotic resistance profiles of invasive MRSA infections and determine risk factors associated with invasive MRSA infections in newborn inpatients. METHODS This multicenter retrospective study of inpatients from eleven hospitals in the Infectious Diseases Surveillance of Pediatrics (ISPED) group of China was performed over a two-year period (2018-2019). Statistical significance was calculated by applying the χ2 test or by Fisher's exact test in the case of small sample sizes. RESULTS A total 220 patients were included. Among included cases, 67 (30.45%) were invasive MRSA infections, including two deaths (2.99%), while 153 (69.55%) were noninvasive infections. The invasive infections of MRSA occurred at a median age of 8 days on admission, which was significantly younger compared to 19 days in noninvasive cases. Sepsis (86.6%) was the most common invasive infection, followed by pneumonia (7.4%), bone and joint infections (3.0%), central nervous system infection (1.5%), and peritonitis (1.5%). Congenital heart disease, low birth weight infant (<2500 g), but not preterm neonates, and bronchopulmonary dysplasia, were more commonly found in invasive MRSA infections. All these isolates were susceptible to vancomycin and linezolid and were resistant to penicillin. Additionally, 69.37% were resistant to erythromycin, 57.66% to clindamycin, 7.04% to levofloxacin, 4.62% to sulfamethoxazole-trimethoprim, 4.29% to minocycline, 1.33% to gentamicin, and 3.13% were intermediate to rifampin. CONCLUSION Low age at admission (≤8 days), congenital heart disease, and low birth weight were associated with invasive MRSA infections in neonates, and no isolates resistant to vancomycin and linezolid were found. Determining these risks in suspected neonates may help identify patients with imminent invasive infections who may require intensive monitoring and therapy.
Collapse
Affiliation(s)
- Xia Wu
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Chuanqing Wang
- Department of Clinical Microbiology Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Leiyan He
- Department of Clinical Microbiology Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Hongmei Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Chunmei Jing
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yinghu Chen
- Department of Infectious Diseases, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Aiwei Lin
- Department of Infectious Diseases, Qilu Children's Hospital of Shandong University, Jinan, 250022, China
| | - Huiling Deng
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Huijun Cai
- Department of Clinical Laboratory, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Yiping Chen
- Department of Pediatric Infectious Diseases, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Jinhong Yang
- Department of Clinical Laboratory, Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Ting Zhang
- Department of Gastroenterology and Infectious Diseases, Children's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200040, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Jianhua Hao
- Department of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng, 475000, China
| | - Yuanyuan Huang
- Department of Pediatrics, Bethune First Hospital of Jilin University, Changchun, 130021, China
| | - Hui Yu
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
| |
Collapse
|
4
|
Alidrisi DA, Alharthi W, Alfawaz T. Invasive Community-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection in Children: A Report of Five Cases and Literature Review. Cureus 2023; 15:e37974. [PMID: 37223206 PMCID: PMC10202042 DOI: 10.7759/cureus.37974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Staphylococcus aureus developed resistance against most antibiotics; the most known resistant form is methicillin-resistant Staphylococcus aureus (MRSA), which can be acquired either from healthcare facilities or the community. The prevalence of hospital-acquired MRSA is higher than community-acquired MRSA (CA-MRSA). CA-MRSA has become an emerging infection and has been increasingly reported recently. Usually, CA-MRSA presents with skin and soft tissue infection but can cause severe invasive infection with significant morbidity. Invasive CA-MRSA needs rapid and aggressive treatment to prevent complications. For MRSA bacteremia that is persistent despite appropriate treatment, the possibility of metastatic invasive infection should be thought of. In this case series, we describe five pediatric cases of different age groups that had different presentations for invasive CA-MRSA infection. This report aims to highlight that physicians should be aware of the growing role of CA-MRSA in pediatrics; they should be meticulous in treating patients with CA-MRSA, and be aware of the complications of this disease and the appropriate empiric and target antibiotics regimen for such infections.
Collapse
Affiliation(s)
- Dhuha A Alidrisi
- Pediatric Infectious Diseases, Security Forces Hospital Makkah, Makkah, SAU
| | - Waad Alharthi
- Pediatric Infectious Diseases, King Fahad Specialist Hospital, Dammam, SAU
| | - Tariq Alfawaz
- Pediatric Infectious Diseases, King Fahad Medical City, Riyadh, SAU
| |
Collapse
|
5
|
Wu X, Wang C, He L, Xu H, Jing C, Chen Y, Lin A, Deng J, Cao Q, Deng H, Cai H, Chen Y, Yang J, Zhang T, Huang Y, Hao J, Yu H. Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus isolates in children reported from the ISPED surveillance of bacterial resistance, 2016-2021. Front Cell Infect Microbiol 2023; 13:1102779. [PMID: 36743309 PMCID: PMC9892648 DOI: 10.3389/fcimb.2023.1102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat to public health worldwide. In December 2015, the Infectious Disease Surveillance of Pediatrics (ISPED) program was organized to monitor bacterial epidemiology and resistance trends in children. Methods This retrospective study was conducted from January 2016-December 2021 on patients at eleven ISPED-group hospitals. Results From 2016-2021, a total of 13024 MRSA isolates were obtained from children. The most common age group for patients with MRSA infection was less than 3 years old, and newborns were an important group affected by MRSA infection. MRSA was most commonly isolated from the lower respiratory, an abscess, a secretion, or blood in neonates and from the lower respiratory, an abscess, or the upper respiratory in non-neonates. All isolates were susceptible to vancomycin and linezolid and resistant to penicillin; additionally, 76.88%, 54.97%, 22.30%, 5.67%, 5.14%, 3.63%, and 1.42% were resistant to erythromycin, clindamycin, tetracycline, levofloxacin, sulfamethoxazole-trimethoprim (TMP-SMX), gentamicin, and rifampin, respectively. Between 2016 and 2021, a significant increase was seen in the levofloxacin- and TMP-SMX-resistance rates (from 5.45% to 7.14% and from 4.67% to 6.50%, respectively) among MRSA isolates, along with a significant decrease in the rates of resistance to erythromycin (from 82.61% to 68.08%), clindamycin (from 60.95% to 46.82%), tetracycline (from 25.37% to 17.13%), gentamicin (from 4.53% to 2.82%), and rifampin (from 1.89% to 0.41%). Discussion The antibiotic-resistance rates varied among MRSA isolated from different sources. Because of the high antibiotic resistance rate to clindamycin, this antibiotic is not recommended for empirical treatment of MRSA infections, especially in osteomyelitis.
Collapse
Affiliation(s)
- Xia Wu
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Chuanqing Wang
- Department of Clinical Laboratory, Children’s Hospital of Fudan University, Shanghai, China
| | - Leiyan He
- Department of Clinical Laboratory, Children’s Hospital of Fudan University, Shanghai, China
| | - Hongmei Xu
- Department of Infectious Diseases, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chunmei Jing
- Department of Clinical Laboratory, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yinghu Chen
- Department of Infectious Diseases, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Aiwei Lin
- Department of Infectious Diseases, Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children’s Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huiling Deng
- Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an, China
| | - Huijun Cai
- Department of Clinical Laboratory, Xi’an Children’s Hospital, Xi’an, China
| | - Yiping Chen
- Department of Pediatric Infectious Diseases, Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinhong Yang
- Department of Clinical Laboratory, Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ting Zhang
- Department of Gastroenterology and Infectious Diseases, Children’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuanyuan Huang
- Department of Pediatrics, Bethune First Hospital of Jilin University, Changchun, China
| | - Jianhua Hao
- Department of Infectious Diseases, Kaifeng Children’s Hospital, Kaifeng, China
| | - Hui Yu
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China,*Correspondence: Hui Yu,
| |
Collapse
|
6
|
Thymol Disrupts Cell Homeostasis and Inhibits the Growth of Staphylococcus aureus. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8743096. [PMID: 36034206 PMCID: PMC9392601 DOI: 10.1155/2022/8743096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022]
Abstract
Staphylococcus aureus (S. aureus) is a typical kind of symbiotic bacteria, which can cause human pneumonia, food poisoning, and other health problems. Nowadays, the corresponding prevention and treatment have been a hot issue of general concern in related research areas. However, the mechanism of action against S. aureus is not well understood. In order to tackle such problem, we used broth microdilution to discuss the antibacterial effect of 5-methyl-2-isopropylphenol and determine inhibitory concentration. In addition, membrane potential and lipid peroxidation levels were also measured under experimental conditions. The experimental results suggested that 300 μg/mL thymol might cause cell membrane damage and decrease of NADPH concentration and increase of NADP+ and lipid peroxidation level. In such condition, thymol has the potential to result in membrane rupture and disruption of cellular homeostasis. Furthermore, we also found that NOX2 is involved in maintaining the balance of NADPH/NADP+ in cells. Finally, our work confirms that NOX2 is a potential downstream target for thymol in the cell. Such target can provide specific guidance and recommendations for its application in antifungal activity. Meanwhile, our study also provides a new inspiration for the molecular mechanism of thymol's bacteriostatic action.
Collapse
|
7
|
Gan MY, Lee WL, Yap BJ, Seethor STT, Greenberg RG, Pek JH, Tan B, Hornik CPV, Lee JH, Chong SL. Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:890767. [PMID: 35722477 PMCID: PMC9204066 DOI: 10.3389/fped.2022.890767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Current knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors. Methods We performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs. Results The search yielded 6314 publications, of which 240 studies (N = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17-19%). The CFR was highest for low-income countries [25% (95% CI, 7-43%)], followed by lower-middle [25% (95% CI, 7-43%)], upper-middle [21% (95% CI, 18-24%)] and lowest for high-income countries [12% (95% CI, 11-13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time. Conclusion Young infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42020164321].
Collapse
Affiliation(s)
- Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Li Lee
- Duke-NUS Medical School, Singapore, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel G Greenberg
- Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jen Heng Pek
- Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Bobby Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christoph Paul Vincent Hornik
- Division of Critical Care Medicine, Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
8
|
Grohs E, Hill-Ricciuti A, Kelly N, Messina M, Green DA, Geng W, Annavajhala MK, Zachariah P, Mathema B, Uhlemann AC, Saiman L. Spa Typing of Staphylococcus aureus in a Neonatal Intensive Care Unit During Routine Surveillance. J Pediatric Infect Dis Soc 2021; 10:766-773. [PMID: 34129043 PMCID: PMC8370566 DOI: 10.1093/jpids/piab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/24/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Staphylococcus aureus protein A (spa) typing can be used to expand characterization of the epidemiology of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in neonatal intensive care units (NICU). METHODS From January 2017 to June 2018, twice-monthly surveillance for S. aureus was performed in an academically affiliated NICU. Decolonization of infants colonized with S. aureus included chlorhexidine gluconate bathing and/or mupirocin for those with mupirocin-susceptible strains. Spa typing and mupirocin-resistance testing were performed. Demographic and clinical characteristics were compared between infants colonized with MSSA vs MRSA and infants with and without the most common MSSA spa type, MSSA-t279. RESULTS Overall, 14% and 2% of 1556 hospitalized infants had positive surveillance cultures for MSSA and MRSA, respectively. Thirty-six infants harbored unique MSSA spa types, 5 infants harbored unique MRSA spa types, and 30 MSSA and 6 MRSA spa types were identified in ≥2 infants. No outbreaks were identified during the study period. MSSA-t279 was isolated from 3% of infants and largely detected from infants hospitalized in one section of the NICU; 96% of t279 isolates were mupirocin resistant. Infection rates, length of hospitalization, and mortality were similar among infants initially colonized with t279 vs other MSSA spa types. CONCLUSIONS The MSSA colonization burden was 5-fold larger than that of MRSA. Numerous unique spa types were identified. The most common spa type, MSSA-t279, was not associated with increased morbidity or mortality but was mupirocin resistant and associated with clustered NICU beds. This suggests potential transmission from the environment, shared staff, and/or workflow issues requiring further study. Other decolonization strategies for S. aureus in the NICU are needed.
Collapse
Affiliation(s)
- Emily Grohs
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Present Affiliation: Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexandra Hill-Ricciuti
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole Kelly
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Maria Messina
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Daniel A Green
- Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Wenjing Geng
- Neonatal Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Medini K Annavajhala
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Zachariah
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Barun Mathema
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York, USA,Corresponding Author: Lisa Saiman, MD MPH, Department of Pediatrics, Columbia University Irving Medical Center, 622 West 168th Street, PH 4-470, New York, NY 10032, USA. E-mail:
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Maternal-Fetal Perinatal Transmission of Staphylococcal Infections: A Report of Two Neonates. Case Rep Pediatr 2020; 2020:8886049. [PMID: 32607269 PMCID: PMC7315269 DOI: 10.1155/2020/8886049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Staphylococcal infection in terms of fetus is rare and is associated with either maternal staphylococcal sepsis or colonization that leads to vertical transmission. Antenatal invasive procedures are a recognized risk factor. Most reported newborns with fetal-onset staphylococcal infections have had a worse outcome. We report the story of two newborns who had pustular-bullous skin lesions at birth and responded successfully to antistaphylococcal antibiotics. Both neonates made complete recovery. It is important to suspect clinically the staphylococcal infections when bullous skin lesions are present in the newborn.
Collapse
|
11
|
Antimicrobial Resistance and Molecular Epidemiology of Staphylococcus aureus Causing Bloodstream Infections at Ruijin Hospital in Shanghai from 2013 to 2018. Sci Rep 2020; 10:6019. [PMID: 32265473 PMCID: PMC7138830 DOI: 10.1038/s41598-020-63248-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/27/2020] [Indexed: 12/28/2022] Open
Abstract
Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA) is an important issue associated with significant morbidity and mortality and well known as a predominant pathogen causing bloodstream infection (BSIs) globally. To estimate the antibiotic resistance and molecular characteristics of S. aureus causing BSIs in Shanghai, 120 S. aureus isolates (20 isolates each year) from the patients with S. aureus BSIs from 2013 to 2018 were randomly selected and enrolled in this study. Fifty-three (44.2%) MRSA isolates were determined, and no isolate was found resistant to vancomycin, daptomycin, synercid, linezolid and ceftaroline. The toxin genes tst, sec, seg and sei were found more frequently among MRSA isolates compared with MSSA isolates (all P < 0.0001). Twenty-nine sequence types (STs) were identified, and ST5 (23.3%) was the most common ST, followed by ST398 (11.7%) and ST764 (10.0%). SCCmec II (73.6%) was the most frequent SCCmec type among MRSA isolates. The dominant clonal complexes (CCs) were CC5 (ST5, ST764, ST965 and ST3066; 36.7%) and the livestock-associated clone CC398 (ST398, 11.7%). MRSA-CC5 was the predominant CC among MRSA isolates (37/53, 69.8%), and CC5-II MRSA was found in 34 isolates accounting for 91.9% (34/37) among CC5 MRSA isolates. In addition, all 29 tst-positive MRSA isolates were CC5-MRSA as well. Our study provided the properties and genotypes of S. aureus causing BSIs at Ruijin Hospital in Shanghai from 2013 to 2018, and might suggest of value clues for the further study insights into pathogenic mechanisms intrinsically referring to the development of human-adapted S. aureus clones and their diffusions.
Collapse
|
12
|
Slingerland BCGC, Vos MC, Bras W, Kornelisse RF, De Coninck D, van Belkum A, Reiss IKM, Goessens WHF, Klaassen CHW, Verkaik NJ. Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Resist Infect Control 2020; 9:39. [PMID: 32087747 PMCID: PMC7036242 DOI: 10.1186/s13756-020-0699-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Neonatal Staphylococcus aureus (S. aureus) bacteremia is an important cause of morbidity and mortality. In this study, we examined whether methicillin-susceptible S. aureus (MSSA) transmission and genetic makeup contribute to the occurrence of neonatal S. aureus bacteremia. METHODS A retrospective, single-centre study was performed. All patients were included who suffered from S. aureus bacteremia in the neonatal intensive care unit (NICU), Erasmus MC-Sophia, Rotterdam, the Netherlands, between January 2011 and November 2017. Whole-genome sequencing (WGS) was used to characterize the S. aureus isolates, as was also done in comparison to reference genomes. Transmission was considered likely in case of genetically indistinguishable S. aureus isolates. RESULTS Excluding coagulase-negative staphylococci (CoNS), S. aureus was the most common cause of neonatal bacteremia. Twelve percent (n = 112) of all 926 positive blood cultures from neonates grew S. aureus. Based on core genome multilocus sequence typing (cgMLST), 12 clusters of genetically indistinguishable MSSA isolates were found, containing 33 isolates in total (2-4 isolates per cluster). In seven of these clusters, at least two of the identified MSSA isolates were collected within a time period of one month. Six virulence genes were present in 98-100% of all MSSA isolates. In comparison to S. aureus reference genomes, toxin genes encoding staphylococcal enterotoxin A (sea) and toxic shock syndrome toxin 1 (tsst-1) were present more often in the genomes of bacteremia isolates. CONCLUSION Transmission of MSSA is a contributing factor to the occurrence of S. aureus bacteremia in neonates. Sea and tsst-1 might play a role in neonatal S. aureus bacteremia.
Collapse
Affiliation(s)
- Bibi C G C Slingerland
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Willeke Bras
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - René F Kornelisse
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dieter De Coninck
- BioMérieux SA, Data Analytics, Clinical Unit, Sint-Martens-Latem, Belgium
| | - Alex van Belkum
- BioMérieux SA, Clinical Unit, 38390, La Balme-les-Grottes, France
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wil H F Goessens
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Impact of MRSA Transmission and Infection in a Neonatal Intensive Care Unit in China: A Bundle Intervention Study during 2014-2017. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5490413. [PMID: 31380430 PMCID: PMC6652075 DOI: 10.1155/2019/5490413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/20/2019] [Indexed: 01/10/2023]
Abstract
Objective. To evaluate the efficacy of bundle intervention on healthcare-associated (HA) methicillin-resistant Staphylococcus Aureus (MRSA) infection in the neonatal intensive care unit (NICU). Methods. In this study, 11,277 infants having undergone treatment at the NICU in Xiamen, China, from January 2014 to February 2017 were recruited. We retrospectively reviewed patients' demographic and clinical information. Patients from 2014 to 2015 were treated as the control group and those from 2016 to 2017 were classified as the experimental group. Bundle intervention measures were performed, including screening for MRSA, isolation precautions, training of hand hygiene, cleaning protocols, and decontamination of isolation ward. The HA-MRSA data and compliance of infection control measures between both groups were analyzed. Results. Through bundle interventions, the compliance with the isolation of MRSA raised from 55.88% to 92.86% and hand hygiene compliance increased from 90.07% to 93.23% (P < 0.05). The HA infection decreased from 1.87% to 1.71% (P > 0.05) and HA detection rate of MRSA declined from 2.63‰ to 1.00‰, respectively (P < 0.05). Conclusion. Multifaceted interventions can effectively prevent MRSA infection and transmission; this includes active surveillance, isolation precautions, increased hand hygiene compliance, environmental cleaning, and decontamination.
Collapse
|
14
|
O'Reilly D, O'Connor C, McCallion N, Drew RJ. A retrospective study (2001-2017) of acute and chronic morbidity and mortality associated with Staphylococcus aureus bacteraemia in a tertiary neonatal intensive care unit. Ir J Med Sci 2019; 188:1297-1301. [PMID: 30805770 DOI: 10.1007/s11845-019-01992-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) in NICU patients can cause significant morbidity and mortality. AIMS To review early and late neonatal SAB with regard to risk factors, treatment, acute complications and long-term outcomes. METHODS A retrospective study of laboratory confirmed SAB over a 16-year period (November 2001-January 2017) in a tertiary neonatal unit in Ireland. FINDINGS A total of 74 neonates (MSSA n = 72, MRSA n = 2) were identified; 8.1% (n = 6) early sepsis, 91.8% (n = 68) late sepsis. Low birth weight neonates (born weighing less than 2500 g) 80% (n = 59). Median age to bacteraemia 11 days post-delivery (range = 0-100 days); median onset early sepsis 1.5 days versus late sepsis 12 days. Complications of SAB; cellulitis n = 17, pneumonia n = 12, necrotising enterocolitis n = 7, thromobophlebitis n = 5, skin abscess formation n = 4, osteomyelitis n = 3, endocarditis n = 1. Late SAB mortality 6.4% (n = 3). CONCLUSIONS Preterm and low birth weight infants were at highest risk of SAB. Only a small proportion of affected children had long-term clinical sequelae on follow-up. The high rate of recurrence and breakthrough bacteraemia suggests that early implementation of a targeted anti-staphylococcal antimicrobial regimen may be of particular benefit.
Collapse
Affiliation(s)
- Daniel O'Reilly
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland.
| | - Ciara O'Connor
- Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Naomi McCallion
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Richard J Drew
- Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland
- Department of Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Irish Meningitis and Sepsis Reference Laboratory (IMSRL), Temple Street Children's University Hospital, Dublin 1, Ireland
| |
Collapse
|
15
|
Semple A, O'Currain E, O'Donovan D, Hanahoe B, Keady D, Ní Riain U, Moylett E. Successful termination of sustained transmission of resident MRSA following extensive NICU refurbishment: an intervention study. J Hosp Infect 2018; 100:329-336. [PMID: 30009868 DOI: 10.1016/j.jhin.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/06/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neonatal sepsis is a leading cause of morbidity and mortality in neonatal units worldwide. Meticillin-resistant Staphylococcus aureus (MRSA) has become a leading causative pathogen. Many neonatal units experience endemic colonization and infection of their infants, which is often very challenging to successfully eradicate. AIM To assess the impact of neonatal unit refurbishment and redesign on endemic MRSA colonization and infection. METHODS A retrospective review was carried out over an eight-year period in a 14-cot, level 2-3 neonatal unit in University Hospital Galway, a large university teaching hospital in the West of Ireland. Surveillance, colonization, and infection data for a four-year period pre and four-year period post neonatal unit refurbishment are described. Clinical and microbiological data were collected on all MRSA-colonized and -infected infants between 2008 and 2015. Molecular typing data are available for MRSA isolates. An interrupted time-series design was used, with unit refurbishment as the intervention. FINDINGS Our neonatal unit had a pattern of sustained transmission of endemic resident MRSA strains which we could not eradicate despite repeated standard infection control interventions. Complete unit refurbishment led to successful termination of sustained transmission of these strains. Colonization decreased and no infants were actively infected post refurbishment of the unit. CONCLUSION We report successful termination of sustained transmission of endemic strains of MRSA from our neonatal unit following complete unit redesign and refurbishment.
Collapse
Affiliation(s)
- A Semple
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland.
| | - E O'Currain
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland
| | - D O'Donovan
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland
| | - B Hanahoe
- Division of Clinical Microbiology, University Hospital, Galway, Ireland
| | - D Keady
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - U Ní Riain
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - E Moylett
- Academic Department of Paediatrics, National University of Ireland, Galway, Ireland
| |
Collapse
|
16
|
Risk Factors for Staphylococcus aureus Acquisition in the Neonatal Intensive Care Unit: A Matched Case-Case-Control Study. Infect Control Hosp Epidemiol 2017; 39:46-52. [PMID: 29157314 DOI: 10.1017/ice.2017.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine risk factors independent of length of stay (LOS) for Staphylococcus aureus acquisition in infants admitted to the neonatal intensive care unit (NICU). DESIGN Retrospective matched case-case-control study. SETTING Quaternary-care referral NICU at a large academic children's hospital. METHODS Infants admitted between January 2014 and March 2016 at a level IV NICU who acquired methicillin resistant (MRSA) or susceptible (MSSA) S. aureus were matched with controls by duration of exposure to determine risk factors for acquisition. A secondary post hoc analysis was performed on the entire cohort of at-risk infants for risk factors identified in the primary analysis to further quantify risk. RESULTS In total, 1,751 infants were admitted during the study period with 199 infants identified as having S. aureus prevalent on admission. There were 246 incident S. aureus acquisitions in the remaining at-risk infant cohort. On matched analysis, infants housed in a single-bed unit were associated with a significantly decreased risk of both MRSA (P=.03) and MSSA (P=.01) acquisition compared with infants housed in multibed pods. Across the entire cohort, pooled S. aureus acquisition was significantly lower in infants housed in single-bed units (hazard ratio,=0.46; confidence interval, 0.34-0.62). CONCLUSIONS NICU bed design is significantly associated with S. aureus acquisition in hospitalized infants independent of LOS. Infect Control Hosp Epidemiol 2018;39:46-52.
Collapse
|
17
|
Hensel KO, van den Bruck R, Klare I, Heldmann M, Ghebremedhin B, Jenke AC. Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains. Sci Rep 2017; 7:45014. [PMID: 28322345 PMCID: PMC5359565 DOI: 10.1038/srep45014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/20/2017] [Indexed: 01/15/2023] Open
Abstract
In the course of a hospital management takeover, a microbial outbreak took place in a tertiary neonatal intensive care unit (NICU). Here, we characterize the outbreak and its management. About 4 months prior to takeover, there was a sharp increase in positive isolates for MSSA and multidrug-resistant organisms (MDROs). Simultaneously, the nursing staff sick leave rate increased dramatically which directly correlated with the number of infection/colonization per week (r2 = 0.95, p = 0.02). During the following months we observed several peaks in positive isolates of methicillin-sensitive staphylococcus aureus (MSSA), MDROs and subsequently a vancomycin-resistant enterococcus (VRE) outbreak. Interventional outbreak management measures were only successful after substantial recruitment of additional nursing staff. None of the VRE, but 44% (n = 4) of MDRO and 32% (n = 23) of MSSA colonized infants developed symptomatic infections (p = 0.02). Among the latter, 35% suffered from serious consequences such as osteomyelitis. The most important risk factors for colonization-to-infection progression were low gestational age and birth weight. Nursing staff fluctuation poses a substantial risk for both bacterial colonization and infection in neonates. Comprehensive outbreak management measures are only successful if adequate nursing staff is available. Non resistant strains account for most neonatal infections - possibly due to their limited perception as being harmful.
Collapse
Affiliation(s)
- Kai O. Hensel
- HELIOS University Medical Center Wuppertal, Department of Pediatrics and Neonatology, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Germany
| | | | - Ingo Klare
- Robert-Koch Institute, Wernigerode, Germany
| | - Michael Heldmann
- HELIOS University Medical Center Wuppertal, Department of Pediatrics and Neonatology, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Germany
| | - Beniam Ghebremedhin
- HELIOS University Medical Center Wuppertal, Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Germany
| | - Andreas C. Jenke
- EKO Children' Hospital, Oberhausen, Witten/Herdecke University, Germany
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Ebruke C, Dione MM, Walter B, Worwui A, Adegbola RA, Roca A, Antonio M. High genetic diversity of Staphylococcus aureus strains colonising the nasopharynx of Gambian villagers before widespread use of pneumococcal conjugate vaccines. BMC Microbiol 2016; 16:38. [PMID: 26969294 PMCID: PMC4788959 DOI: 10.1186/s12866-016-0661-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/02/2016] [Indexed: 11/29/2022] Open
Abstract
Background With the global efforts of reducing pneumococcal disease through widespread introduction of pneumococcal vaccines, concerns have emerged on the potential increase of morbidity and mortality from S. aureus disease. Little is known however, of the carriage rates of S. aureus or of its’ relationship with carriage of S. pneumoniae in rural Africa, and West Africa in particular where very high rates of carriage of S. pneumoniae have been reported. This study aims to evaluate the prevalence, antibiotic susceptibility patterns and genotypes of S. aureus isolated from the nasopharynx of healthy individuals in rural Gambia before the introduction of routine use of pneumococcal conjugate vaccines in the country. Results Overall prevalence of S. aureus nasopharyngeal carriage was 25.2 %. All S. aureus isolates tested were susceptible to methicillin. Resistant was observed for sulphamethoxazole-trimethoprim (15 %) and tetracycline (34.3 %). We found 59 different sequence types (ST), 35 of which were novel. The most prevalent sequence types were ST 15 (28 %) and ST 5 (4 %). Eighty two percent (494/600) of study individuals were S. pneumoniae carriers with S. pneumoniae carriage rates decreasing with increasing age groups. S. aureus carriage among pneumococcal carriers was slightly lower than among non-pneumococcal carriers (24.3 versus 29.3 %; p = 0.324). There were no associations of carriage between these two bacteria across the 4 age groups. However, analysis of pooled data children < 2 years and children 2 to < 5 years of age showed a statistically significant inverse association (24.1 and 50.0 % for S. aureus carriage among S. pneumoniae carriers and non-carriers respectively; p = 0.015). Conclusions We report that nasopharyngeal carriage of S. aureus in rural Gambia is high in all age groups, with approximately 1 out of 4 individuals being carriers in the pre-pneumococcal vaccination era. There are indications that nasopharyngeal carriage of S.aureus could be inversely related to carriage of S. pneumoniae amongst younger children in The Gambian and that S. aureus clones in The Gambia show significant genetic diversity suggesting worldwide dissemination. Findings from this study provide a useful background for impact studies evaluating the introduction of pneumococcal vaccines or other interventions targeting the control of S. aureus infections and disease.
Collapse
Affiliation(s)
- Chinelo Ebruke
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel M Dione
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Brigitte Walter
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Archibald Worwui
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | | | - Anna Roca
- Disease Control and Elimination, Medical Research Council Unit, Banjul, The Gambia
| | - Martin Antonio
- Vaccine and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. .,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| |
Collapse
|
20
|
Horner K, Yamada M, Zuccoli G, Rosenberg S, Greene S, Vellody K, Zuckerbraun NS. A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, and Staphylococcus aureus Bacteremia. Pediatrics 2016; 137:peds.2015-1406. [PMID: 26644490 DOI: 10.1542/peds.2015-1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/24/2022] Open
Abstract
A 34-day-old previously healthy boy born full term presented to the emergency department with fever at home (38.1°C), fussiness, and decreased oral intake for 1 day. He was difficult to console at home. He had decreased oral intake without emesis, diarrhea, or a change in urine output. He did not have rhinorrhea, cough, or increased work of breathing noted by parents. He lived at home with his parents and 13-year-old brother, did not attend day care, and had no sick contacts. On examination, he was fussy but consolable. He was febrile to 39.3°C, tachycardic (180 beats per minute), and tachypneic (64 breaths per minute), with mottling and a capillary refill of 3 seconds. The remainder of his examination was normal, without an infectious focus for his fever. A complete blood cell count with differential revealed leukocytosis. A basic metabolic panel was normal. A catheter urinalysis was normal. Cerebrospinal fluid examination yielded pleocytosis, low glucose, and elevated protein. Blood cultures were persistently positive with methicillin-sensitive Staphylococcus aureus, but cerebrospinal fluid cultures remained negative. We present his case, management, and ultimate diagnosis.
Collapse
Affiliation(s)
| | | | | | | | - Stephanie Greene
- Neurosurgery, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Weese JS, Giguère S, Guardabassi L, Morley PS, Papich M, Ricciuto DR, Sykes JE. ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance. J Vet Intern Med 2015; 29:487-98. [PMID: 25783842 PMCID: PMC4895515 DOI: 10.1111/jvim.12562] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 12/22/2022] Open
Abstract
The epidemic of antimicrobial resistant infections continues to challenge, compromising animal care, complicating food animal production and posing zoonotic disease risks. While the overall role of therapeutic antimicrobial use in animals in the development AMR in animal and human pathogens is poorly defined, veterinarians must consider the impacts of antimicrobial use in animal and take steps to optimize antimicrobial use, so as to maximize the health benefits to animals while minimizing the likelihood of antimicrobial resistance and other adverse effects. This consensus statement aims to provide guidance on the therapeutic use of antimicrobials in animals, balancing the need for effective therapy with minimizing development of antimicrobial resistance in bacteria from animals and humans.
Collapse
Affiliation(s)
- J S Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
23
|
Blanchard AC, Quach C, Autmizguine J. Staphylococcal infections in infants: updates and current challenges. Clin Perinatol 2015; 42:119-32, ix. [PMID: 25678000 DOI: 10.1016/j.clp.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Staphylococci are common pathogens in the neonatal period. Increased survival of premature infants leads to prolonged hospital stay with associated risk factors for developing invasive staphylococcal disease. Challenges of diagnosing coagulase-negative staphylococcal infections result in conflicting definitions and inconsistent clinical practice. Resistance to methicillin influences the choice of empirical therapy.
Collapse
Affiliation(s)
- Ana C Blanchard
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Caroline Quach
- Division of Infectious Diseases, Department of Medical Microbiology, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Julie Autmizguine
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec H3T 1J4, Canada; Research Center CHU Sainte-Justine, 3175 Chemin Côte Sainte Catherine, Montreal, Quebec H3T 1C5, Canada.
| |
Collapse
|
24
|
Kraus-Haas M, Mielke M, Simon A. [Update on outbreaks reported from neonatal intensive care units (2010-203): Staphylococcus aureus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:323-38. [PMID: 25566845 DOI: 10.1007/s00103-014-2115-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In terms of the unique risk profile of the patients and the morbidity associated with S. aureus infections in this vulnerable patient population, the literature on outbreaks of S. aureus (including MRSA) in neonatal intensive care units (NICUs) needs to be analyzed separately from reports derived from other intensive care units. With the objective of updating important information for those involved in outbreak management and fostering preventive efforts, this article summarizes the results of a systematic literature analysis, referring to an earlier publication by Gastmeier et al. It focuses on NICU outbreaks caused by S. aureus (including MRSA) and on controlling them.
Collapse
|
25
|
Pereira VC, Riboli DFM, da Cunha MDLRDS. Characterization of the clonal profile of MRSA isolated in neonatal and pediatric intensive care units of a University Hospital. Ann Clin Microbiol Antimicrob 2014; 13:50. [PMID: 25376654 PMCID: PMC4228086 DOI: 10.1186/s12941-014-0050-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/17/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) are important pathogens in neonatal and pediatric intensive care units, which can cause severe infections in hospitalized children. Detection of the mecA gene and classification of the staphylococcal cassette chromosome mec (SCCmec) permit the characterization of MRSA strains isolated from infections caused by these microorganisms. In contrast, pulsed-field gel electrophoresis (PFGE) is used to type MRSA clones. This method is commonly used to analyze the epidemiology of bacteria causing nosocomial infections. The objective of this study was to detect and characterize MRSA isolated from clinical specimens of children hospitalized in the neonatal and pediatric intensive care units of the University Hospital of the Botucatu Medical School. METHODS A total of 119 S. aureus strains were isolated from clinical specimens and the mecA gene was detected by PCR. SCCmec was detected by multiplex PCR and the clonal profile was analyzed by PFGE. RESULTS The mecA gene was detected in 17.6% (21/119) of the isolates; 42.9% (9/21) of MRSA were characterized as SCCmec type III and 57.1% (12/21) as type IV. Analysis of the clonal profile of these strains revealed three distinct clones, with SCCmec type III being related to the Brazilian endemic clone and type IV to clones JCSC4469 and USA800. CONCLUSIONS Replacement of clonal groups occurred in the neonatal and pediatric units over the period studied, a fact highlighting the importance of improving hygiene practices and control measures of nosocomial infections in these units.
Collapse
Affiliation(s)
- Valéria Cataneli Pereira
- Laboratory of Bacteriology, Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Danilo Flávio Moraes Riboli
- Laboratory of Bacteriology, Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Laboratory of Bacteriology, Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, CEP 18618-970, Brazil.
| |
Collapse
|