Garcia Cilmara P, Rosa Juliana F, Cursino Maria A, Lobo Renata D, Mollaco Carla H, Gobara Satiko, Malieno Paula B, Raymundo Gabriela F, Soares Robson E, Keil Kleiste G, Toma Edi, Salomão Matias C, Matté M Helena, Krebs Vera L, Gibelli M Augusta, Kondo Mario M, Zugaib Marcelo, Costa Silvia F, Levin Anna S
From the *Department of Infectious Diseases and LIM-54; †Department of Infection Control, Hospital das Clínicas; ‡Department of Pediatrics; §Faculty of Public Health; ¶Department of Obstetrics; and ‖Instituto de Medicina Tropical de São Paulo, University of São Paulo, São Paulo, Brazil.
Pediatr Infect Dis J. 2014 Oct;33(10):e252-9. doi: 10.1097/INF.0000000000000435.
In the last decade, non-multiresistant methicillin-resistant Staphylococcus aureus (NM-MRSA) has been described as an important agent in bloodstream infections in our hospital.
This prospective cohort study, conducted from February 2009 through January 2010 in the neonatal unit, evaluated 403 newborns (NB), their 382 mothers and 148 health care workers (HCW).
Approximately 217 NB (54%), 187 mothers (48%) and 87 HCW (59%) were colonized by S. aureus (SA). MRSA colonization was greater among NB (15%) than mothers (4.7%) and HCW (3.4%). Although mother-to-NB transmission occurred, in most cases mothers were not responsible for NB colonization. There were 2 predominant PFGE patterns among the NB and some mothers and HCW became colonized by them. Factors significantly associated with MRSA carriage by NB were lower level of maternal schooling (risk factor: odds ratio: 2.99; 95% confidence interval: 1.10-8.07) and maternal rhinosinusitis (protective factor: odds ratio: 0.33; 95% confidence interval:0.12-0.88). Among NB who remained hospitalized for more than 72 hours, breast feeding was protective (odds ratio: 0.22; 95% confidence interval: 0.05-0.98). All the isolates were NM-MRSA, carried few virulence factors and SCCmec types IVa and type IVd predominated.
Although there were no cases of infection, nosocomial transmission of MRSA clearly occurred in the neonatal unit, and this highlights the need for infection control practices such as hand hygiene to prevent cross-dissemination. Other healthcare practices, which are very basic but also ample in scope, may play a role, such as general education of women and breast feeding.
在过去十年中，非多重耐药性耐甲氧西林金黄色葡萄球菌（NM-MRSA）被认为是我院血流感染的重要病原体。
这项前瞻性队列研究于2009年2月至2010年1月在新生儿病房进行，评估了403名新生儿（NB）、他们的382名母亲和148名医护人员（HCW）。
约217名新生儿（54%）、187名母亲（48%）和87名医护人员（59%）被金黄色葡萄球菌（SA）定植。耐甲氧西林金黄色葡萄球菌（MRSA）定植在新生儿中（15%）比母亲（4.7%）和医护人员（3.4%）更常见。虽然存在母婴传播，但在大多数情况下母亲并非新生儿定植的源头。新生儿和部分母亲及医护人员中存在两种主要的脉冲场凝胶电泳（PFGE）图谱。与新生儿携带MRSA显著相关的因素包括母亲受教育程度较低（危险因素：比值比：2.99；95%置信区间：1.10 - 8.07）和母亲患鼻窦炎（保护因素：比值比：0.33；95%置信区间：0.12 - 0.88）。在住院超过72小时的新生儿中，母乳喂养具有保护作用（比值比：0.22；95%置信区间：0.05 - 0.98）。所有分离株均为NM-MRSA，携带的毒力因子较少，以IVa型和IVd型葡萄球菌盒式染色体mec（SCCmec）为主。
虽然没有感染病例，但新生儿病房中耐甲氧西林金黄色葡萄球菌的医院内传播明显存在，这凸显了采取如手卫生等感染控制措施以防止交叉传播的必要性。其他一些非常基本但范围广泛的医疗保健措施可能也发挥作用，如对女性的健康教育和母乳喂养。
