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Updated: Aug 8, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Effects of Discontinuation of Weekly Surveillance Testing on Methicillin-Resistant Staphylococcus aureus in the NICU
Rebecca Y Petersen1, Noah H Hillman1, Farouk H Sadiq1
1Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri.
Objective:
Methicillin-resistant Staphylococcus aureus (MRSA) infection is a major cause of serious morbidity and mortality in the neonatal intensive care unit (NICU). There is no clear consensus on infection control measures. Some approaches to MRSA colonization management may be burdensome with unclear benefits. The objective of this study was to determine if stopping weekly MRSA surveillance with active detection and contact isolation (ADI) was associated with a change in infection rate.
Study Design:
This is a retrospective cohort study of infants admitted to two affiliated NICUs. The ADI cohort infants received weekly nasal MRSA cultures and were placed in contact isolation if MRSA colonized for the duration of their hospitalization. The No Surveillance cohort infants were only placed in isolation if there was active MRSA infection or if MRSA colonization was identified incidentally. The rates of infection were determined between the cohorts.
Results:
There were 8,406 neonates representing 193,684 NICU days in the comparison period. In the ADI cohort, MRSA colonization occurred in 3.4% of infants and infection occurred in 29 infants (0.4%). There were no differences between cohorts in the percent of infants with a MRSA infection at any site (0.5 vs. 0.5%, p = 0.89), rate of MRSA infections per 1,000 patient-days (0.197 vs. 0.201, p = 0.92), rate of bloodstream infections (0.12 vs. 0.26%, p = 0.18), or in the overall mortality rate (3.7 vs. 3.0% p = 0.13). ADI represented an annual cost of $590,000.
Conclusion:
The rates of MRSA infection did not change when weekly ADI was discontinued and was associated with a decrease in cost and resource utilization.
Key Points:
· Placing MRSA-colonized infants in contact isolation is a common practice.. · Data are limited with respect to efficacy in the NICU.. · This study provides evidence that active detection and contact isolation for MRSA colonization may not be beneficial..
Insights
Stopping weekly surveillance for methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs) did not increase infection rates. This change reduced costs and resource use without impacting patient outcomes.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Infections
- Infection Control Practices
- Antibiotic Resistance
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses significant risks in the NICU.
- Current MRSA infection control strategies, including active detection and contact isolation (ADI), lack clear consensus on efficacy and can be resource-intensive.
- The benefits of routine MRSA surveillance and isolation for colonized neonates remain uncertain.
Purpose of the Study:
- To evaluate the impact of discontinuing weekly MRSA surveillance with ADI on MRSA infection rates in two NICUs.
- To assess the association between changes in MRSA surveillance protocols and NICU infection rates.
- To determine the cost-effectiveness of MRSA surveillance and isolation practices.
Main Methods:
- A retrospective cohort study comparing infants under weekly MRSA surveillance with ADI to those without.
- Infants in the ADI cohort underwent weekly nasal MRSA cultures and isolation if colonized.
- The No Surveillance cohort received isolation only for active infection or incidental colonization.
- Infection rates, bloodstream infections, and mortality were compared between cohorts.
Main Results:
- No significant difference in MRSA infection rates was observed between the ADI and No Surveillance cohorts (0.5% vs. 0.5%).
- Rates of MRSA infections per 1,000 patient-days and bloodstream infections did not differ significantly between groups.
- Discontinuing ADI resulted in substantial cost savings, estimated at $590,000 annually, with no increase in overall mortality.
Conclusions:
- Discontinuation of weekly MRSA surveillance with active detection and contact isolation is not associated with an increased rate of MRSA infection in the NICU.
- The findings suggest that routine MRSA surveillance and isolation for colonization may not be beneficial and can be reduced to optimize resource utilization.
- Reducing ADI practices can lead to significant cost savings and decreased resource burden without compromising patient safety in the NICU.
