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Eradication of epidemic methicillin-gentamicin-resistant staphylococcus aureus in an intensive care nursery
Abstract:
A methicillin-resistant strain of Staphylococcus aureus (phage type 47,54,75,83A) became epidemic in our 50 bed level III nursery, with a colonization rate of 70 percent and an infection rate of more than 25 percent. This prevalence and the appearance of gentamicin resistance necessitated epidemic control measures. Standard measures included separate housing for infants in whom colonization had occurred and infants in whom it had not, low nurse to patient ratios, and cohorting of all personnel. Use of all antibiotics was curtailed by the requirement of infectious disease consultation. Gentamicin was available only on order of the Director. The colonization rate fell from 55 percent to 25.4 percent, the first-week colonization rate from 31 percent to 0 percent, and the infection rate from 29.3 percent to 15.9 percent over eight weeks. The mean duration of antibiotic therapy decreased from 12.21 to 9.05 days per treated patient; however, the frequency of gentamicin usage and the proportion of gentamicin resistance were unchanged. Nurse to patient ratios were modified to allow increased admissions, but cohorting was continued for 12 weeks until all infants in whom colonization had occurred were discharged. With the elimination of the reservoir, no further colonization occurred and antibiotic resistance did not reappear. Standard infection control measures can eliminate epidemics of multiple antibiotic-resistant Staph. aureus, and control of antibiotic usage may present re-emergence of resistant strains.
Insights
Strict infection control measures effectively reduced methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection rates in a neonatal intensive care unit. Controlling antibiotic use is key to preventing resistant strains from re-emerging.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- An epidemic of methicillin-resistant Staphylococcus aureus (MRSA), phage type 47,54,75,83A, occurred in a 50-bed level III nursery.
- High colonization (70%) and infection (25%) rates, coupled with gentamicin resistance, necessitated urgent control measures.
- The specific MRSA strain exhibited resistance to gentamicin, complicating treatment options.
Purpose of the Study:
- To implement and evaluate epidemic control measures for a multi-drug resistant MRSA outbreak.
- To assess the impact of stringent infection control and antibiotic stewardship on MRSA prevalence and resistance.
- To determine the effectiveness of standard infection control practices in eliminating MRSA reservoirs.
Main Methods:
- Implementation of standard infection control measures: infant isolation, low nurse-to-patient ratios, and personnel cohorting.
- Antibiotic stewardship: restricted antibiotic use requiring infectious disease consultation and director approval for gentamicin.
- Monitoring of colonization and infection rates, antibiotic therapy duration, and gentamicin resistance over an eight-week period.
Main Results:
- Significant reduction in colonization rates from 55% to 25.4% and infection rates from 29.3% to 15.9% within eight weeks.
- First-week colonization rate decreased from 31% to 0%.
- Mean antibiotic therapy duration reduced; however, gentamicin usage and resistance rates remained unchanged during the intervention period.
Conclusions:
- Standard infection control measures successfully eliminated the MRSA epidemic and eradicated the resistant strain reservoir.
- Controlled antibiotic usage is crucial for preventing the re-emergence of antibiotic-resistant strains.
- The study demonstrates the efficacy of comprehensive infection control strategies in managing multi-drug resistant bacterial outbreaks in neonatal units.