Gregory Mary Lucia, Eichenwald Eric C, Puopolo Karen M
Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rose Building, Room 318, Boston, MA 02215, USA.
Pediatrics. 2009 May;123(5):e790-6. doi: 10.1542/peds.2008-1526.
The objectives of this study were to determine the incidence rates of neonatal methicillin-resistant Staphylococcus aureus colonization and infection after the implementation of a NICU methicillin-resistant S aureus surveillance and isolation program and to describe the characteristics of infants with methicillin-resistant S aureus colonization and invasive disease.
From August 2000 through August 2007, all infants admitted to the study NICU were screened for methicillin-resistant S aureus colonization with weekly nasal/rectal swabs; colonized or infected infants were isolated and cared for as a cohort. The annual incidence rates of methicillin-resistant S aureus colonization and infection were monitored, and characteristics of methicillin-resistant S aureus-colonized and -infected infants were compared. Data were collected from infant, maternal, and hospital laboratory records.
During the study period, 7997 infants were admitted to the NICU and 102 methicillin-resistant S aureus-colonized or -infected infants (1.3%) were identified. The incidence of methicillin-resistant S aureus decreased progressively from 1.79 cases per 1000 patient-days in 2000 to 0.15 cases per 1000 patient-days in 2005, but the incidence then increased to 1.26 cases per 1000 patient-days in 2007. Fifteen of the 102 case infants (14.7%) had invasive infections; no significant differences between infected and colonized infants were identified. Methicillin-resistant S aureus isolates with 14 different antibiograms were found during the study period. There was a shift from isolates predominantly likely to be hospital-associated in 2000-2004 to those likely to be community-associated in 2006-2007.
A continuous program of weekly methicillin-resistant S aureus surveillance cultures and isolation of affected infants was associated with a variable incidence of methicillin-resistant S aureus colonization over a 7-year study period. Methicillin-resistant S aureus was not eradicated from this tertiary-care NICU, and our data suggest that infants were colonized by multiple different methicillin-resistant S aureus strains during the study period.
本研究的目的是确定实施新生儿重症监护病房（NICU）耐甲氧西林金黄色葡萄球菌监测和隔离计划后，新生儿耐甲氧西林金黄色葡萄球菌定植和感染的发生率，并描述耐甲氧西林金黄色葡萄球菌定植和侵袭性疾病婴儿的特征。
从2000年8月至2007年8月，对入住本研究NICU的所有婴儿每周进行鼻/直肠拭子筛查，以检测耐甲氧西林金黄色葡萄球菌定植情况；对定植或感染的婴儿进行隔离，并作为一个队列进行护理。监测耐甲氧西林金黄色葡萄球菌定植和感染的年发生率，并比较耐甲氧西林金黄色葡萄球菌定植和感染婴儿的特征。数据收集自婴儿、母亲和医院实验室记录。
在研究期间，7997名婴儿入住NICU，其中102名婴儿（1.3%）被鉴定为耐甲氧西林金黄色葡萄球菌定植或感染。耐甲氧西林金黄色葡萄球菌的发生率从2000年的每1000个患者日1.79例逐渐下降至2005年的每1000个患者日0.15例，但随后在2007年又升至每1000个患者日1.26例。102例病例婴儿中有15例（14.7%）发生侵袭性感染；感染婴儿和定植婴儿之间未发现显著差异。在研究期间发现了14种不同抗菌谱的耐甲氧西林金黄色葡萄球菌分离株。从2000 - 2004年主要为医院相关分离株转变为2006 - 2007年可能为社区相关分离株。
在为期7年的研究期间，每周持续进行耐甲氧西林金黄色葡萄球菌监测培养并隔离受影响婴儿的计划与耐甲氧西林金黄色葡萄球菌定植的发生率变化有关。耐甲氧西林金黄色葡萄球菌在这家三级护理NICU中未被根除，我们的数据表明在研究期间婴儿被多种不同的耐甲氧西林金黄色葡萄球菌菌株定植。
