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Outbreak of Methicillin Resistant Staphylococcus aureus (MRSA) in a Neonatal Intensive Care Unit (NICU): A Previously Virgin Island within a Sea of Adult MRSA Infections

Galang M, Bartel J, Parada JP, Challapalli M, Schreckenberger P, Johnson S. Outbreak of Methicillin Resistant Staphylococcus aureus (MRSA) in a Neonatal Intensive Care Unit (NICU): A Previously Virgin Island within a Sea of Adult MRSA Infections. Poster session presented at: Society for Healthcare Epidemiology of America Annual Scientific Meeting; 2006 Mar 1; Chicago, IL.




Abstract:

Background: Despite methicillin resistance in 47% of nosocomial S. aureus isolates and 9.6 cases of nosocomial MRSA infections per month in our hospital in 2003, there were no MRSA infections recognized in the Level III Neonatal Intensive Care Unit (NICU). In March 2004, a case of MRSA pneumonia was recognized in the NICU, followed by another pneumonia case 5 months later, and an eye infection 2 months after that infection. In December, a task force was formed and interventions initiated when additional cases were identified.Objective: To describe the MRSA outbreak and the effect of our intervention.Methods: All available MRSA isolates from the NICU and 10 isolates from adult patients with nosocomial MRSA infections during the same time period were typed by repetitive sequence-based PCR (rep-PCR). A case-control study was performed to look for risk factors associated with infection by the major NICU MRSA clone. Cases were defined as infection with the major clone. Controls were non-MRSA infected and matched by birth weight, gestational age at delivery and hospitalization in the NICU during the same time period as the cases. Interventions included: education of health-care workers (HCW), reinforcement of hand-hygiene and contact isolation for infected babies, active surveillance cultures (ASC) using nasal swabs of all babies and cohorting those colonized with MRSA. Surveillance cultures of HCW were considered, but not performed.Results: Ten nosocomial MRSA infections were identified from 1/2004 to 11/2005. Fourteen additional infants were found to be colonized with MRSA by ASC. Four different MRSA clonal groupings were identified among 13 NICU MRSA isolates, one clone accounting for 7 of the NICU infections (54%). A separate NICU clone, seen in 2 infants was identical or nearly identical to the clone seen in all 10 adult patients. The case-control study showed no significant difference in length of hospital stay, intravenous/arterial catheter days, total ventilator days, type of feeding or surgical procedures done. After increasing ASC frequency to weekly at the end of March our MRSA infection rate was cut in half (0.5 to 0.24 infections/1,000 patient days, RR 0.48, 95% CI 0.10-2.26, P = 0.278). There have been no MRSA infections for the last 6 months although ASC still detects occasional colonized infants.Conclusion: Despite no apparent MRSA infections for over 1 years, a polyclonal outbreak developed in our NICU that was related, at least in part, to introductions from the main hospital where MRSA infection has been endemic for many years. The NICU outbreak was controlled successfully by ASC and cohorting of colonized infants without screening HCWs. Ongoing ASC will likely be necessary; however the optimal frequency of screening is unknown.





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