An Outbreak of Staphylococcus aureus in Neonatal Special Care Units of Maharat Nakhon Ratchasima Hospital
Article Sidebar
Main Article Content
Abstract
Staphylococcus aureus (S. aureus) is an important cause of hospital-acquired infections (HAIs) in neonates. Methicillin-resistant S. aureus (MRSA) infection has steadily increased and accounted for many reported outbreaks. Objective: To describe the epidemiology and the interventions used to control an outbreak of hospital-acquired S. aureus infections in a NICU and spcial care nurseries (SCNs) in Maharat Nakhon Ratchasima Hospital. Methods: Investigation of the outbreak was conducted between March-May 2008. Interventions to control S. aureus infection included strict contract precautions, active surveillance cultures, and decolonization of patients and health care workers. Results: A cluster of 8 cases of MRSA and 11 cases of methicillin-sensitive S. aureus (MSSA) infection represented an attack rate of 0.71 % and 0.97 % respectively. Types of infection included line-associated bloodstream infection or BSI-Line (5 cases; 26.3%), BSI non-line (6 cases; 31.6%), skin and skin structure infection or SSTI (5 cases; 26.3%), surgical site infection or SSI (2 cases; 10.53%), and meningitis (1 case; 5.3%). Neonates infected with MRSA had longer length of stay before acquiring infection (mean 46.3 days; range 7-115 days) than those infected with MSSA (mean 21.9 days; range 4-90 days). The outbreak was terminated in August 2008. Conclusion: This outbreak illustrates that patients in SCNs and NICU are at high risk for HAIs with MRSA and MSSA. Bloodstream infections, either line-associated or non-line were most common. The combination of strict contact precautions, active surveillance cultures, and decolonization were crucial in outbreak eradication.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Stoll BJ. Neonatal infections: A global perspective. In: Remington JS, Klein JO, editors. Infectious diseases of the fetus and newborn infant. 5 th ed. Philadelphia: WB saunders; 2001. p. 139-68.
Chaikittisuk N. Methicillin-resistant Staphylococcus aureus infections in children at Queen Sirikit National Institute of Child Health. J infect Dis Antimicrob Agents 2003; 20: 73-9.
ปราณี เคหะจินดาวัฒน์, บรรจง วรรณยิ่ง, ประนอม มานู, ศิริรัตน์ ตันสุทธากูล. การระบาดของเชื้อ MRSA. จุลสารชมรมควบคุมโรคติดเชื้อในโรงพยาบาลแห่งประเทศไทย 2537; 4: 11-3.
Hall SL. Coagulase-negative staphylococcal infections in neonates. Pediatr Infect Dis J 1991; 10: 57.
Microbiology Report 1998-2002. Maharat Nakhon Ratchasima Hospital.
Microbiology Report 2003-2007. Maharat Nakhon Ratchasima Hospital.
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 17th internal supplement. CLSI, 2007.
Jernigan JA, Clemence MA, Stott GA, Titus MG, Alexander CH, Palumbo CM, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995; 16: 686-96.
อะเคื้อ อุณหเลขกะ. การติดเชื้อในโรงพยาบาล. ระบาดวิทยาและการป้องกัน. พิมพ์ครั้งที่ 1 เชียงใหม่: มิ่งเมือง; 2545.
Wenzel RP, Reagan DR, Bertino JS Jr, Baron EJ, Arias K. Methicillin-resistant Staphylococcus aueus outbreak; a consensus panel’s definition and management guidelines. Am J Infect Control 1998; 26: 102-10.
Proctor RA. Staphylococcus. In: APIC Text of infection control and epidemiology. Association for professionals in infection control and epidemiology. Washington DC: 2005. p. 691-6-5. Available from www.apic.org
Gillbert GL, Asche V, Hewstone AS, Mathieson JL. Methicillin-resistant Staphylococcus aureus in neonatal nurseries. Two years experience in special care nurseries in Melbourne. Med J Aust 1982; 1: 455-9.
Davies EA, Emmerson AM, Hogg GM, Patterson MF, Shields MD. An outbreak of infection with a methicillinresistant Staphylococcus aureus in a special care baby unit. Value of topical mupirocin and of traditional methods of infection control. J Hosp infect 1987; 10: 120-8.
Reboli AC, Lenkoff AH. Epidemic methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child 1989; 143: 34-9.
Farrington M, Ling J, Ling T, French GL. Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burn units of a new hospital. Epidemiol infect 1990; 105: 215-28.
Saiman L, Cronquist A, Wu F, Zhou J, Rubenstein D, Eisner W, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003; 24: 317-21.
Regev-Yochay G, Rubinstein E, Barzilai A, Carmeli Y, Kuint J, Etienne J, et al. Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit. Emerg Infect Dis 2005 ; 11 : 453-6.
Adams-Chapman I, Stoll BJ. Nosocomial infections in the nursery. In: Taeusch HW, Ballard R, Gleason CA, editors. Avery’s diseases of the newborn. 8th ed. Philadelphia: Elsevier Saunders; 2005. p. 578-94.
Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97: 309-17.
Merrer J, Santoli F, Appere d e Vecchi C, Tran B, De Jonghe B, Outin H. “Colonization pressure” and risk of acquisition of methicllin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000; 21: 718-23.
Marshall C, Wesselingh S, McDonald M, Spelman D. Control of endemic MRSA-what is the evidence? A personal view. J Hosp Infect 2004; 253-68.
Lucet JC, Paoletti X, Lolom I. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005; 31: 1051-7.
Haley RW, Bregman DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982; 145: 875-85.
Andersen BM, Lindemann R, Bergh K. Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 2002; 50: 18-24.
Siegel JD, Rhinehart E, Jackson M, Chiarello L. Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Available from www.cdc.gov/ncidod/dhqp/pdf/ar/MDRO Guideline 2006.pdf
Back NA, Linnemann CC Jr, Staneck JL, Kotagal UR. Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: use of intensive microbiologic surveillance and mupirocin. Infect Control Hosp Epidemiol 1996; 17: 227-31.
Haley RW, Cushion NB, Tenover FC, Bannerman TL, Dryer D, Ross J, et al. Eradication of endemic methicillinresistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995; 17: 614-24.
Jernigan JA, Titus MG, Groschel DH, Getchell-White S, Farr BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996; 143: 496-504.
Khoury J, Jones M, Grim A, Dunne WM Jr, Fraser V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005; 26: 616-21.
Shitrit P, Gottesman BS, Katzir M, Kilman A, Ben-Nissan Y, Chowers M. Active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) decreases the incidence of MRSA bacteremia. Infect Control Hosp Epidemiol 2006; 27: 1004-8.
Jourdan DR, Rupp ME, O’Neill JM, Overfelt CM, Bolan DL. Sequential approach to a MRSA outbreak in a neonatal ICU. Am J infect Control 2007; 35: E132-E133.
Buehlmann M, Frei R, Fenner L, Dangel M, Fluckiger U, Widmer AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008; 29: 510-6.
Verhof J, Beaujean D, Blok H, Baars A, Meyler A, van der Werken C, et al. A Dutch approach to methicillinresistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999; 18: 461-6.
Wertheim HF, Vos MC, Boelens HA, Voss A, Vandenbroucke-Grauls CM, Meester MH, et al. Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect 2004; 56: 321-5.
Susan Mayor London. European surveillance shows north-south divide in resistant bacteria. News roundup. Br Med J 2002; 324: 697.