Department of Microbiology, Paediatrics and Infection Control, London North West Healthcare, London, UK.
Faculty of Medicine, Imperial College, London, UK.
BMC Infect Dis. 2019 Feb 20;19(1):178. doi: 10.1186/s12879-019-3802-0.
In January 2011, there was an outbreak of Panton-Valentine Leukocidin-positive methicillin-sensitive Staphylococcus aureus (PVL-MSSA) infection in a neonatal unit (NNU). We describe the investigation and control of an outbreak of PVL-MSSA infection in neonates.
Neonatal unit in West London.
We performed descriptive and analytical (case-control study) epidemiological investigations. Microbiological investigations including screening of MSSA isolates by PCR for the presence of the luk-PV, mecA and mecC genes and comparison of isolate with Pulsed field gel electrophoresis (PFGE). Control measures were also introduced.
Sixteen babies were infected/colonised with the outbreak strain. Of these, one baby developed blood stream infection, 12 developed skin pustules and four babies were colonised. Four mothers developed breast abscesses. Eighty-seven babies in the unit were screened and 16 were found to have same PVL-MSSA strain (spa type t005, belonging to MLST clonal complex 22). Multivariate analysis showed gestational age was significantly lower in cases compared to controls (mean gestational age: 31.7 weeks v 35.6 weeks; P = 0.006). Length of stay was significantly greater for cases, with a median of 25 days, compared to only 6 days for controls (P = 0.01). Most (88%) cases were born through caesarean section, compared to less than half of controls. (P = 0.002). No healthcare worker carriers and environmental source was identified. The outbreak was controlled by stopping new admissions to unit and reinforcing infection control precautions. The outbreak lasted for seven weeks. No further cases were reported in the following year.
Infection control teams have to be vigilant for rising prevalence of particular S. aureus clones in their local community as they may cause outbreaks in vulnerable populations in healthcare settings such as NNUs.
2011 年 1 月，新生儿病房（NNU）发生了泛型-Valentine 白细胞溶素阳性耐甲氧西林金黄色葡萄球菌（PVL-MSSA）感染暴发。我们描述了对新生儿 PVL-MSSA 感染暴发的调查和控制。
伦敦西部的新生儿病房。
我们进行了描述性和分析性（病例对照研究）流行病学调查。微生物学调查包括通过 PCR 筛选 MSSA 分离株以检测 luk-PV、mecA 和 mecC 基因的存在，并将分离株与脉冲场凝胶电泳（PFGE）进行比较。还引入了控制措施。
16 名婴儿感染/定植了暴发菌株。其中，1 名婴儿发生血流感染，12 名婴儿发生皮肤脓疱，4 名婴儿定植。4 名母亲发生乳腺炎。对该病房的 87 名婴儿进行筛查，发现 16 名婴儿携带相同的 PVL-MSSA 菌株（spa 型 t005，属于 MLST 克隆复合体 22）。多变量分析显示，病例组的胎龄明显低于对照组（平均胎龄：31.7 周对 35.6 周；P=0.006）。病例组的住院时间明显长于对照组，中位数为 25 天，而对照组仅为 6 天（P=0.01）。大多数（88%）病例是剖宫产分娩，而对照组不到一半（P=0.002）。未发现医护人员携带者和环境来源。通过停止新入院和加强感染控制预防措施控制了暴发。暴发持续了七周。在接下来的一年中没有报告新的病例。
感染控制团队必须警惕当地社区中特定金黄色葡萄球菌克隆的流行率上升，因为它们可能在医疗机构（如新生儿病房）中导致弱势群体暴发感染。
