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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009
Olajide Dolapo1, Ramasubbareddy Dhanireddy, Ajay J Talati
1Department of Pediatrics, Division of Neonatology, University of Tennessee Health Science Center, Suite 201, 853 Jefferson Avenue, Memphis, TN 38163-0001, USA. odolapo1@uthsc.edu.
Background:
Invasive methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections are major causes of numerous neonatal intensive care unit (NICU) outbreaks. There have been increasing reports of MRSA outbreaks in various neonatal intensive care units (NICUs) over the last decade. Our objective was to review the experience of Staphylococcus aureus sepsis in our NICU in the last decade and describe the trends in the incidence of Staphylococcus aureus blood stream infections from 2000 to 2009.
Methods:
A retrospective perinatal database review of all neonates admitted to our NICU with blood cultures positive for Staphylococcus aureus from (Jan 1st 2000 to December 31st 2009) was conducted. Infants were identified from the database and data were collected regarding their clinical characteristics and co-morbidities, including shock with sepsis and mortality. Period A represents patients admitted in 2000-2003. Period B represents patients seen in 2004-2009.
Results:
During the study period, 156/11111 infants were identified with Staphylococcus aureus blood stream infection: 41/4486 (0.91%) infants in Period A and 115/6625 (1.73%) in Period B (p < 0.0004). Mean gestation at birth was 26 weeks for infants in both periods. There were more MRSA infections in Period B (24% vs. 55% p < 0.05) and they were associated with more severe outcomes. In comparing the cases of MRSA infections observed in the two periods, infants in period B notably had significantly more pneumonia cases (2.4% vs. 27%, p = 0.0005) and a significantly higher mortality rate (0% vs. 15.7%, p = 0.0038). The incidences of skin and soft tissue infections and of necrotizing enterocolitis were not significantly changed in the two periods.
Conclusion:
There was an increase in the incidence of Staphylococcus aureus infection among neonates after 2004. Although MSSA continues to be a problem in the NICU, MRSA infections were more prevalent in the past 6 years in our NICU. Increased severity of staphylococcal infections and associated rising mortality are possibly related to the increasing MRSA infections with a more virulent community-associated strain.
Insights
Neonatal intensive care unit (NICU) Staphylococcus aureus bloodstream infections increased after 2004, with methicillin-resistant Staphylococcus aureus (MRSA) becoming more prevalent and severe. This trend is linked to more virulent strains and rising mortality rates in neonates.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Epidemiology
Background:
- Invasive Staphylococcus aureus infections, including methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA), are significant causes of outbreaks in neonatal intensive care units (NICUs).
- There has been a documented rise in MRSA outbreaks within NICUs over the past decade, highlighting an evolving challenge in neonatal infection control.
Purpose of the Study:
- To review the incidence and trends of Staphylococcus aureus bloodstream infections (BSIs) in a NICU population over a ten-year period (2000-2009).
- To compare the characteristics and outcomes of Staphylococcus aureus infections between two distinct periods to identify changes in prevalence and severity.
Main Methods:
- A retrospective review of a perinatal database identified neonates with Staphylococcus aureus BSIs admitted to the NICU between January 1, 2000, and December 31, 2009.
- Data collected included clinical characteristics, comorbidities, sepsis with shock, and mortality.
- Infants were categorized into two periods: Period A (2000-2003) and Period B (2004-2009) for comparative analysis.
Main Results:
- The overall incidence of Staphylococcus aureus BSIs in neonates significantly increased from 0.91% in Period A to 1.73% in Period B (p < 0.0004).
- MRSA infections became more prevalent in Period B (55% vs. 24% in Period A, p < 0.05) and were associated with more severe outcomes, including a significant rise in pneumonia cases (27% vs. 2.4%, p = 0.0005) and mortality (15.7% vs. 0%, p = 0.0038).
- The incidence of skin and soft tissue infections and necrotizing enterocolitis did not significantly change between the two periods.
Conclusions:
- Staphylococcus aureus infection incidence rose in neonates after 2004, with MRSA infections becoming more common and severe in the NICU.
- The increasing prevalence of MRSA, potentially due to more virulent community-associated strains, is linked to heightened infection severity and rising mortality rates.
- While MSSA remains a concern, the shift towards more aggressive MRSA infections necessitates updated infection control strategies in NICUs.
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