Saiman Lisa, Cronquist Alicia, Wu Fann, Zhou Juyan, Rubenstein David, Eisner William, Kreiswirth Barry N, Della-Latta Phyllis
Department of Pediatrics Columbia University and New York Presbyterian Medical Center, Children's Hospital of New York, New York, New York 10032, USA.
Infect Control Hosp Epidemiol. 2003 May;24(5):317-21. doi: 10.1086/502217.
To describe the epidemiologic and molecular investigations that successfully contained an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU).
Isolates of MRSA were typed by pulsed-field gel electrophoresis (PFGE) and S. aureus protein A (spa).
A level III-IV, 45-bed NICU located in a children's hospital within a medical center.
Incident cases had MRSA isolated from clinical cultures (eg, blood) or surveillance cultures (ie, anterior nares).
Infected and colonized infants were placed on contact precautions, cohorted, and treated with mupirocin. Surveillance cultures were performed for healthcare workers (HCWs). Colonized HCWs were treated with topical mupirocin and hexachlorophene showers.
From January to March 2001, the outbreak strain of MRSA, PFGE clone B, was harbored by 13 infants. Three (1.3%) of 235 HCWs were colonized with MRSA. Two HCWs, who rotated between the adult and the pediatric facility, harbored clone C. One HCW, who exclusively worked in the children's hospital, was colonized with clone B. From January 1999 to November 2000, 22 patients hospitalized in the adult facility were infected or colonized with clone B. Spa typing and PFGE yielded concordant results. PFGE clone B was identified as spa type 16, associated with outbreaks in Brazil and Hungary.
A possible route of MRSA transmission was elucidated by molecular typing. MRSA appears to have been transferred from our adult facility to our pediatric facility by a rotating HCW. Spa typing allowed comparison of our institution's MRSA strains with previously characterized outbreak clones.
描述成功控制新生儿重症监护病房（NICU）耐甲氧西林金黄色葡萄球菌（MRSA）暴发的流行病学和分子学调查。
采用脉冲场凝胶电泳（PFGE）和金黄色葡萄球菌蛋白A（spa）对MRSA分离株进行分型。
位于医疗中心内一家儿童医院的三级至四级、拥有45张床位的NICU。
发病病例的MRSA分离自临床培养物（如血液）或监测培养物（即前鼻孔）。
对感染和定植的婴儿采取接触预防措施、进行分组，并使用莫匹罗星治疗。对医护人员（HCW）进行监测培养。对定植的医护人员使用局部莫匹罗星和六氯酚沐浴治疗。
2001年1月至3月，13名婴儿携带MRSA暴发菌株PFGE克隆B。235名医护人员中有3人（1.3%）定植有MRSA。两名在成人和儿科机构之间轮岗的医护人员携带克隆C。一名仅在儿童医院工作的医护人员定植有克隆B。1999年1月至2000年11月，22名在成人机构住院的患者感染或定植有克隆B。Spa分型和PFGE结果一致。PFGE克隆B被鉴定为spa型16，与巴西和匈牙利的暴发有关。
通过分子分型阐明了MRSA可能的传播途径。MRSA似乎通过一名轮岗的医护人员从我们的成人机构传播到了儿科机构。Spa分型使我们机构的MRSA菌株能够与先前特征明确的暴发克隆进行比较。
