Popoola Victor O, Colantuoni Elizabeth, Suwantarat Nuntra, Pierce Rebecca, Carroll Karen C, Aucott Susan W, Milstone Aaron M
1Division of Pediatric Infectious Diseases,Department of Pediatrics,Johns Hopkins University School of Medicine,Baltimore,Maryland.
2Department of Biostatistics,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
Infect Control Hosp Epidemiol. 2016 Apr;37(4):381-7. doi: 10.1017/ice.2015.316. Epub 2016 Jan 4.
Staphylococcus aureus is a common cause of healthcare-associated infections in neonates.
To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance.
We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models.
Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected.
Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
金黄色葡萄球菌是新生儿医疗保健相关感染的常见病因。
研究甲氧西林敏感金黄色葡萄球菌（MSSA）去定植对MSSA感染发生率的影响，并测定莫匹罗星耐药率。
我们回顾性确定了2011年4月1日至2014年9月30日期间入住三级医疗新生儿重症监护病房（NICU）的新生儿。我们比较了对MSSA定植新生儿实施主动监测培养和去定植干预前后MSSA阳性培养物和感染的发生率。我们使用两种测量方法来确定主要结局，即NICU相关MSSA：（1）在常规临床护理期间送检的任何培养物中培养出MSSA，以及（2）任何培养出MSSA且符合国家医疗安全网络医疗保健相关感染监测定义标准的培养物。对金黄色葡萄球菌分离株进行莫匹罗星敏感性测试。我们使用中断时间序列模型估计发病率比。
干预前后，分别有1523名新生儿（29220个患者日）和1195名新生儿（22045个患者日）入住NICU。干预实施后，NICU相关MSSA阳性临床培养物的平均季度发病率立即下降了64%（发病率比，0.36 [95% CI，0.19 - 0.70]），MSSA阳性培养率继续以每季度21%的速度下降（发病率比，0.79 [95% CI，0.74 - 0.84]）。干预实施后，MSSA感染也立即下降了73%（发病率比，0.27 [95% CI，0.10 - 0.79]）。未检测到莫匹罗星耐药。
主动监测培养和去定植可能有效降低NICU中的金黄色葡萄球菌感染。
