Bertin Mary L, Vinski Joan, Schmitt Steven, Sabella Camille, Danziger-Isakov Lara, McHugh Michael, Procop Gary W, Hall Geraldine, Gordon Steven M, Goldfarb Johanna
Department of Infection Control and Epidemiology, Division of Nursing, The Cleveland Clinic, Cleveland, OH 44195, USA.
Infect Control Hosp Epidemiol. 2006 Jun;27(6):581-5. doi: 10.1086/504933. Epub 2006 May 25.
To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).
Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).
Level III NICU in a tertiary care center.
Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual.
Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.
Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.
An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.
描述在新生儿重症监护病房（NICU）控制耐甲氧西林金黄色葡萄球菌（MRSA）定植和感染暴发所需的调查及干预措施。
回顾性病例查找，包括通过重复序列聚合酶链反应（rep-PCR）进行前瞻性监测培养以检测MRSA及对MRSA进行分子分型。
一家三级医疗中心的三级NICU。
2004年4月16日，NICU中有3名新生儿被确诊为MRSA血流感染。一项现患率调查又发现了6名定植的新生儿（罹患率为75%[12名新生儿中的9名]）。暴发菌株在表型上不常见。
对在暴发期间获得MRSA的新生儿实施同室隔离并给予莫匹罗星治疗。在NICU引入接触预防措施，并对医护人员（HCW）重新进行清洁、消毒程序及手卫生方面的培训。未定植的新生儿和新入院患者每周进行3次监测培养。
1个月后又发现2名新的定植新生儿。自2003年6月起就在NICU工作的HCW X被确诊患有慢性中耳炎。从HCW X的耳道和鼻腔拭子标本培养物中分离出MRSA。HCW X在流行病学上与此次暴发有关联。分子分型（通过rep-PCR）证实，来自HCW X和新生儿的分离株相似度超过90%。对NICU分离株的回顾性分析显示，暴发菌株最初是在HCW X开始在该科室工作2个月后从一名新生儿中培养出来的。将HCW X调离NICU的患者护理岗位后，流行菌株被根除。
NICU中MRSA定植和感染的暴发在流行病学上与一名患有慢性外耳道炎且鼻腔定植有MRSA的医护人员有关。在将HCW X调离NICU之前，疫情未能得到控制。对MRSA的常规监测可能有助于更早地识别此次暴发，目前这在我们的NICU已成为标准做法。
