Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG.
Braz J Infect Dis. 2009 Jun;13(3):177-82. doi: 10.1590/s1413-86702009000300005.
Staphylococcus aureus and coagulase-negative staphylococci are the main cause of sepsis in Neonatal Intensive Care Unit (NICU). Central venous catheters (CVCs) are an important part of critical neonates' treatment and are associated with sepsis. The aim of this study was to investigate two outbreaks caused by Staphylococcus aureus and Staphylococcus epidermidis associated with CVC inserted by phlebotomy in critical neonates. The surveillance was performed from January 2001 to December 2005 at the Brazilian NICU. The genotypic analysis of oxacillin susceptible S. aureus (OSSA) and oxacillin resistant S. epidermidis (ORSE) was performed based on pulsed-field gel electrophoresis (PFGE). Staphylococcus was the most frequent pathogen (65.8%) with highest incidence of CoNS (59.9%) followed by S. aureus (40.1%). During the five years of surveillance, there were two outbreaks detected, occurred in January-February/02 and August/02 and confirmed by PFGE analysis. The predisposing factors for infection corresponding to both outbreaks were: age < or =7 days, hospitalization > or =7 days, and use of polyethylene CVC through dissection of vein (phlebotomy). This is the first relate of staphylococcal outbreaks associated with CVC inserted by phlebotomy in NICU. PFGE showed polyclonal spread of OSSA during both epidemic and endemic period, and two monoclonal outbreaks of ORSE in the same epidemic period of OSSA.
金黄色葡萄球菌和凝固酶阴性葡萄球菌是新生儿重症监护病房（NICU）败血症的主要原因。中心静脉导管（CVC）是危重新生儿治疗的重要组成部分，与败血症有关。本研究旨在调查两起由经采血插入的耐甲氧西林金黄色葡萄球菌（MRSA）和表皮葡萄球菌（MRES）引起的与 CVC 相关的爆发。该监测于 2001 年 1 月至 2005 年 12 月在巴西 NICU 进行。对耐苯唑西林敏感的金黄色葡萄球菌（OSSA）和耐苯唑西林表皮葡萄球菌（ORSE）进行了基于脉冲场凝胶电泳（PFGE）的基因分析。金黄色葡萄球菌是最常见的病原体（65.8%），凝固酶阴性葡萄球菌的发病率最高（59.9%），其次是金黄色葡萄球菌（40.1%）。在五年的监测期间，发现了两起暴发，分别发生在 2002 年 1 月至 2 月和 2002 年 8 月，并通过 PFGE 分析得到证实。与这两起暴发相关的感染危险因素是：年龄≤7 天，住院时间≥7 天，经静脉切开术（采血）使用聚乙烯 CVC。这是首次报道 NICU 中与经采血插入的 CVC 相关的葡萄球菌暴发。PFGE 显示 OSSA 在流行和流行期间呈多克隆传播，而在同一 OSSA 流行期间出现了两起 MRES 的单克隆暴发。
