Division of Infectious Disease, Children's National Health System, Washington, DC.
Division of Neonatal Intensive Care Unit, Children's National Health System, Washington, DC.
Infect Control Hosp Epidemiol. 2019 Oct;40(10):1123-1127. doi: 10.1017/ice.2019.217. Epub 2019 Jul 31.
The value of decolonization as a strategy for preventing methicillin-resistantStaphylococcus aureus (MRSA) in the neonatal intensive care unit (NICU) remains to be determined.
After adding decolonization to further reduce MRSA transmission in our NICU, we conducted this retrospective review to evaluate its effectiveness.
The review included patients who were admitted to our NICU between April 2015 and June 2018 and were eligible for decolonization including twice daily intranasal mupirocin and daily chlorhexidine gluconate bathing over 5 consecutive days. Patients were considered successfully decolonized if 3 subsequent MRSA screenings conducted at 1-week intervals were negative. The MRSA acquisition rate (AR) was calculated as hospital-acquired (HA) MRSA per 1,000 patient days (PD) and was used to measure the effectiveness of the decolonization.
Of the 151 MRSA patients being reviewed, 78 (51.6%) were HA-MRSA, resulting in an overall AR of 1.27 per 1,000 PD. Between April 2015 and February 2016, when only the decolonization was added, the AR was 2.38 per 1,000 PD. Between March 2016 and June 2018 after unit added a technician dedicated to the cleaning of reusable equipment, the AR decreased significantly to 0.92 per 1,000 PD (P < .05). Of the 78 patients who were started on the decolonization, 49 (62.8%) completed the protocol, 11 (14.1%) remained colonized, and 13 (16.7%) were recolonized prior to NICU discharge.
In a NICU with comprehensive MRSA prevention measures in place, enhancing the cleaning of reusable equipment, not decolonization, led to significant reduction of MRSA transmission.
去殖民化作为预防新生儿重症监护病房（NICU）耐甲氧西林金黄色葡萄球菌（MRSA）的策略的价值仍有待确定。
在我们的 NICU 中增加去殖民化以进一步降低 MRSA 的传播后，我们进行了这项回顾性研究以评估其效果。
该研究纳入了 2015 年 4 月至 2018 年 6 月期间入住我们 NICU 并符合去殖民化条件的患者，包括每天两次鼻腔涂抹莫匹罗星和连续 5 天使用洗必泰沐浴。如果在 1 周间隔内进行的 3 次后续 MRSA 筛查均为阴性，则认为患者去殖民化成功。MRSA 获得率（AR）以每 1000 个患者日（PD）发生的医院获得性（HA）MRSA 来计算，用于衡量去殖民化的效果。
在 151 名正在接受审查的 MRSA 患者中，78 名（51.6%）为 HA-MRSA，总体 AR 为每 1000 PD 1.27。2015 年 4 月至 2016 年 2 月，仅增加去殖民化时，AR 为每 1000 PD 2.38。2016 年 3 月至 2018 年 6 月，单位增加了一名专门负责清洁可重复使用设备的技术人员后，AR 显著下降至每 1000 PD 0.92（P <.05）。在开始去殖民化的 78 名患者中，49 名（62.8%）完成了方案，11 名（14.1%）仍定植，13 名（16.7%）在 NICU 出院前再次定植。
在已经实施了综合 MRSA 预防措施的 NICU 中，增强对可重复使用设备的清洁，而不是去殖民化，可显著降低 MRSA 的传播。
