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Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit
Q Haddad1, E I Sobayo, O B Basit
1Division of Infectious Diseases, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia.
Abstract:
An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in a neonatal intensive care unit (NICU) over a period of 2 months involving 16 babies, mainly of low birth weight. Arbitrary grouping of the isolates showed that there were apparently three different strains involved in the outbreak, as determined only by antibiogram. Twenty-three out of 27 isolates were allocated to 'group 1' based on antibiotic sensitivity pattern. Control of spread of the MRSA in the unit was difficult because of some technical constraints but eradication was finally achieved by cohort nursing and treatment with topical mupirocin in paraffin base. All MRSA isolates were resistant to gentamicin, erythromycin, tetracycline and at least four other antibiotics but sensitive to vancomycin. Overcrowding, limited space, inadequate cleaning of the equipment and initial lack of correct attitude to scrupulous handwashing techniques, all appeared to contribute to the ease of spread of the strains involved.
Insights
A neonatal intensive care unit (NICU) outbreak involving 16 low birth weight infants was caused by methicillin-resistant Staphylococcus aureus (MRSA). Cohort nursing and topical mupirocin successfully eradicated the MRSA strains.
Area of Science:
- Infectious Diseases
- Neonatal Medicine
- Microbiology
Background:
- An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) affected 16 infants in a neonatal intensive care unit (NICU).
- The outbreak involved primarily low birth weight infants and persisted for two months.
- Antibiotic sensitivity patterns suggested the involvement of three distinct MRSA strains.
Purpose of the Study:
- To investigate the characteristics and control of an MRSA outbreak in a NICU.
- To identify factors contributing to the spread of MRSA within the unit.
- To evaluate the effectiveness of intervention strategies for MRSA eradication.
Main Methods:
- MRSA isolates were characterized using antibiogram analysis to determine strain diversity.
- Data on patient demographics, clinical course, and environmental factors were collected.
- Intervention strategies including cohort nursing and topical mupirocin treatment were implemented.
Main Results:
- Twenty-three out of 27 MRSA isolates belonged to 'group 1' based on antibiotic sensitivity.
- All MRSA isolates exhibited resistance to multiple antibiotics including gentamicin, erythromycin, and tetracycline, but remained sensitive to vancomycin.
- Factors contributing to spread included overcrowding, inadequate cleaning, and suboptimal handwashing practices.
Conclusions:
- MRSA outbreaks in NICUs pose significant challenges due to multidrug resistance.
- Effective control requires a combination of stringent infection control measures, including cohort nursing and appropriate topical antimicrobial therapy.
- Addressing environmental and behavioral factors is crucial for preventing and eradicating MRSA transmission in healthcare settings.