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Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit: use of intensive
N A Back1, C C Linnemann, J L Staneck
1Infection Control Department, University of Cincinnati Hospital, OH 45267-0788, USA.
Objective:
To describe the epidemiology and the interventions used to control two methicillin-resistant Staphylococcus aureus (MRSA) epidemics involving 46 infants with two fatalities in a neonatal intensive care unit (NICU).
Setting:
A 50-bed, level III NICU in a university hospital.
Interventions:
After traditional interventions failed to stop the first epidemic, an intensive microbiologic surveillance (IMS) program was developed. Cultures were obtained on all infants each week, and those colonized with MRSA were isolated. When an infant was found to be colonized with MRSA, cultures immediately were obtained on all surrounding infants. This was continued until no MRSA-colonized infants were found in the area. During the first epidemic, mupirocin was used in an attempt to eradicate the organism from the unit.
Results:
All infants, colonized and noncolonized, and parents of and personnel working with colonized infants were treated simultaneously with 5 days of mupirocin. This failed to eradicate MRSA in colonized infants. The spread of MRSA ceased in the unit, but a second epidemic occurred 4 months later. This time, IMS alone was successful in quickly containing the epidemic, and MRSA disappeared from the unit after all colonized infants were discharged. Plasmid analysis demonstrated that the same strain was responsible for both outbreaks.
Conclusions:
IMS and isolation are effective in containing the spread of MRSA in an NICU. The use of mupirocin failed to eradicate the organism.
Insights
Intensive microbiologic surveillance and isolation effectively contained methicillin-resistant Staphylococcus aureus (MRSA) epidemics in a neonatal intensive care unit (NICU). Topical mupirocin treatment failed to eradicate MRSA in infants.
Area of Science:
- Neonatal intensive care unit (NICU) epidemiology
- Infection control in healthcare settings
- Antimicrobial resistance surveillance
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in neonatal intensive care units (NICUs).
- Two MRSA epidemics occurred in a university hospital's level III NICU, affecting 46 infants and resulting in two fatalities.
- Traditional interventions and topical mupirocin failed to eradicate MRSA during the initial epidemic.
Purpose of the Study:
- To describe the epidemiology of two MRSA epidemics in a NICU.
- To evaluate the effectiveness of interventions, including intensive microbiologic surveillance (IMS) and isolation, in controlling MRSA spread.
- To assess the role of mupirocin in MRSA eradication.
Main Methods:
- Implementation of an intensive microbiologic surveillance (IMS) program involving weekly cultures of all infants.
- Isolation of MRSA-colonized infants and cultures of surrounding infants upon detection.
- Application of mupirocin treatment to all infants, parents, and personnel during the first epidemic.
Main Results:
- The IMS program, combined with isolation, successfully contained the second MRSA epidemic.
- MRSA was eradicated from the NICU after all colonized infants were discharged.
- Plasmid analysis confirmed the same MRSA strain was responsible for both outbreaks.
- Mupirocin treatment failed to eradicate MRSA in colonized infants.
Conclusions:
- Intensive microbiologic surveillance (IMS) and isolation are effective strategies for controlling MRSA spread in NICUs.
- Mupirocin is not effective for eradicating MRSA colonization in NICU infants.
- Effective infection control measures are crucial for preventing and managing MRSA outbreaks in vulnerable neonatal populations.