Kim Young Hee, Chang Sung Soo, Kim Yang Soo, Kim Ellen Ai-Rhan, Yun Sung Cheol, Kim Ki Soo, Pi Soo Young
Division of Neonatology, Department of Pediatrics, Clinical Research Center, University of Ulsan College of Medicine, Seoul, Korea.
Neonatology. 2007;91(4):241-7. doi: 10.1159/000098171. Epub 2006 Dec 22.
Methicillin-resistant Staphylococcus aureus (MRSA) colonization can persist for prolonged periods, and patient-related factors are associated with persistent carriage in adults. However, such knowledge is lacking among neonates.
To better understand the outcome of MRSA-colonized neonates in the neonatal intensive care unit (NICU), we prospectively followed all colonized neonates until decolonization over 39 months and determined the incidence, duration of colonization, clinical outcomes and risk factors associated with prolonged carriage of MRSA.
Nasal and inguinal cultures were obtained from all newly admitted neonates following an outbreak of MRSA. Weekly and 1-2 monthly cultures were obtained from all hospitalized and discharged neonates colonized with MRSA, respectively, until 2 consecutive cultures were negative.
152 of 1,456 (10.4%) neonates became colonized. The mean time to acquire MRSA colonization was 17.1 +/- 40.7 (range 1-471) days. The median time to decolonization was 36 days. About 20% of decolonized patients had been colonized for a prolonged period of >or=160 days. 47.5% of colonized patients were sent home colonized, and none with prolonged carriage developed MRSA-related infections in the following 6 months in contrast to 6 infants (3.9%) who developed MRSA sepsis during hospitalization. The only risk factor associated with prolonged carriage was the concurrent colonization of both the inguinal and nasal areas on admission.
Nearly all neonates with acquired colonization became decolonized either prior to or after discharge from NICU. A significant percentage failed to decolonize prior to hospital discharge, but almost all decolonized by 30 months in the community without evidence of systemic or local infections.
耐甲氧西林金黄色葡萄球菌（MRSA）定植可能会长期持续存在，在成人中，与患者相关的因素与持续携带该病菌有关。然而，新生儿中缺乏此类相关知识。
为了更好地了解新生儿重症监护病房（NICU）中MRSA定植新生儿的转归情况，我们对所有定植新生儿进行了为期39个月的前瞻性随访，直至病菌清除，并确定了MRSA长期携带的发生率、定植持续时间、临床转归及相关危险因素。
在MRSA暴发后，对所有新入院的新生儿进行鼻腔和腹股沟拭子培养。对所有住院和出院的MRSA定植新生儿分别每周和每月1 - 2次进行培养，直至连续2次培养结果为阴性。
1456例新生儿中有152例（10.4%）发生定植。获得MRSA定植的平均时间为17.1±40.7（范围1 - 471）天。清除定植的中位时间为36天。约20%的已清除定植患者曾长期定植≥160天。47.5%的定植患者出院时仍为定植状态，在接下来的6个月中，长期携带病菌的患者均未发生与MRSA相关的感染，相比之下，有6例婴儿（3.9%）在住院期间发生了MRSA败血症。与长期携带相关的唯一危险因素是入院时腹股沟和鼻腔区域同时定植。
几乎所有获得性定植的新生儿在从NICU出院前或出院后均实现了病菌清除。相当一部分新生儿在出院前未能清除病菌，但几乎所有患儿在社区中到30个月时均已清除病菌，且无全身或局部感染的证据。
