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Updated: Jun 23, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Seven-year experience with a surveillance program to reduce methicillin-resistant Staphylococcus aureus colonization
Mary Lucia Gregory1, Eric C Eichenwald, Karen M Puopolo
1Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rose Building, Room 318, Boston, MA 02215, USA. mgregory@bidmc.harvard.edu
Objectives:
The objectives of this study were to determine the incidence rates of neonatal methicillin-resistant Staphylococcus aureus colonization and infection after the implementation of a NICU methicillin-resistant S aureus surveillance and isolation program and to describe the characteristics of infants with methicillin-resistant S aureus colonization and invasive disease.
Methods:
From August 2000 through August 2007, all infants admitted to the study NICU were screened for methicillin-resistant S aureus colonization with weekly nasal/rectal swabs; colonized or infected infants were isolated and cared for as a cohort. The annual incidence rates of methicillin-resistant S aureus colonization and infection were monitored, and characteristics of methicillin-resistant S aureus-colonized and -infected infants were compared. Data were collected from infant, maternal, and hospital laboratory records.
Results:
During the study period, 7997 infants were admitted to the NICU and 102 methicillin-resistant S aureus-colonized or -infected infants (1.3%) were identified. The incidence of methicillin-resistant S aureus decreased progressively from 1.79 cases per 1000 patient-days in 2000 to 0.15 cases per 1000 patient-days in 2005, but the incidence then increased to 1.26 cases per 1000 patient-days in 2007. Fifteen of the 102 case infants (14.7%) had invasive infections; no significant differences between infected and colonized infants were identified. Methicillin-resistant S aureus isolates with 14 different antibiograms were found during the study period. There was a shift from isolates predominantly likely to be hospital-associated in 2000-2004 to those likely to be community-associated in 2006-2007.
Conclusions:
A continuous program of weekly methicillin-resistant S aureus surveillance cultures and isolation of affected infants was associated with a variable incidence of methicillin-resistant S aureus colonization over a 7-year study period. Methicillin-resistant S aureus was not eradicated from this tertiary-care NICU, and our data suggest that infants were colonized by multiple different methicillin-resistant S aureus strains during the study period.
Insights
A neonatal intensive care unit (NICU) surveillance program showed variable rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in infants. The program did not eradicate MRSA, indicating ongoing challenges with this pathogen in NICU settings.
Area of Science:
- Neonatal infectious diseases
- Hospital epidemiology
- Antimicrobial resistance
Background:
- Neonatal intensive care units (NICUs) are vulnerable to healthcare-associated infections.
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat to vulnerable infant populations.
- Effective surveillance and isolation strategies are crucial for controlling MRSA in NICUs.
Purpose of the Study:
- To determine the incidence of MRSA colonization and infection in neonates following a surveillance and isolation program.
- To characterize infants with MRSA colonization and invasive disease within the NICU.
- To evaluate the long-term impact of a NICU-specific MRSA control program.
Main Methods:
- Prospective surveillance of all infants admitted to a NICU from 2000 to 2007.
- Weekly nasal and rectal swabs for MRSA screening.
- Isolation and cohorting of colonized or infected infants; data collection from medical records.
Main Results:
- 1.3% of 7997 infants screened were colonized or infected with MRSA.
- MRSA incidence decreased initially but later increased, showing variability over the study period.
- 14.7% of MRSA-positive infants developed invasive infections; multiple MRSA strains, including community-associated types, were identified.
Conclusions:
- A continuous MRSA surveillance and isolation program in a NICU resulted in variable incidence rates over seven years.
- MRSA was not eradicated, highlighting the persistent challenge of controlling this pathogen in tertiary-care NICUs.
- The emergence of diverse MRSA strains, including community-associated ones, suggests complex transmission dynamics.
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