The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.

Faced with expectations to improve patient safety and contain costs, the US health care system is under increasing pressure to comprehensively and objectively account for nosocomial infections. Widely accepted nosocomial infection surveillance methods, however, are limited in scope, not sensitive, and applied inconsistently. In 907 inpatient admissions to Evanston Northwestern Healthcare hospitals (Evanston, IL), nosocomial infection identification by the Nosocomial Infection Marker (MedMined, Birmingham, AL), an electronic, laboratory-based marker, was compared with hospital-wide nosocomial infection detection by medical records review and established nosocomial infection detection methods. The sensitivity and specificity of marker analysis were 0.86 (95% confidence interval [CI 95], 0.76-0.96) and 0.984 (CI 95, 0.976, 0.992). Marker analysis also identified 11 intensive care unit-associated nosocomial infections (sensitivity, 1.0; specificity, 0.986). Nosocomial Infection Marker analysis had a comparable sensitivity (P > .3) to and lower specificity (P < .001) than medical records review. It is important to note that marker analysis statistically outperformed widely accepted surveillance methods, including hospital-wide detection by Study on the Efficacy of Nosocomial Infection Control chart review and intensive care unit detection by National Nosocomial Infections Surveillance techniques.

Nasal carriage of Staphylococcus aureus is considered a source of subsequent infection in health care settings. Utilization of real-time polymerase chain reaction (PCR) for detection of S. aureus has the potential to dramatically affect infection control practice by rapidly identifying S. aureus-colonized patients. We developed and validated the use of real-time PCR for detection of S. aureus colonization in two patient populations. Paired nasal swabs were collected from 299 neonates and from 151 adult patients at Evanston Hospital. One swab was used for culture and the other placed into a bacterial lysis solution containing achromopeptidase. The DNA liberated was used as the template for real-time PCR with primers for the femA gene. SYBR Green was used for amplicon detection. In the neonatal population the sensitivity, specificity, predictive value positive and predictive value negative for culture and PCR was 92% versus 96%, 100% versus 100%, 100% versus 100%, and 98% versus 99%, respectively. In the adults the results were 90% versus 100%, 100% versus 98%, 100% versus 96%, and 95% versus 100%, respectively. Real-time PCR was able to detect S. aureus in 2 hours compared to 1 to 4 days for culture and provided sensitivity equal to or greater than culture.

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During an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in the neonatal intensive care units at two hospitals, we assessed several sites for detection of MRSA colonization. Nasal cultures found 32 of 33 MRSA-colonized patients (97%). Rectal cultures detected 29% of 24 MRSA-colonized patients identified by paired rectal and nasal samples and axillary samples found 22% of 9 MRSA-colonized patients identified by axillary samples paired with nasal swabs. There were no positive umbilical samples.Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a cause of epidemics in the neonatal intensive care unit (NICU) (4, 9, 13). High rates of colonization (30 to 70%) may occur before clinical infections indicate a problem (14, 17). However, there are few data on the appropriate body site(s) for microbiologic surveillance of MRSA among neonates. As a result, there are widely differing practices for the detection of MRSA that involve culturing multiple sites, including the anterior nares, umbilicus, pharynx, catheter sites, rectum, groin, and axilla, as well as any open wounds (1,6,18). During a recent outbreak of MRSA in the NICUs at two hospitals, we compared (i) nasal versus rectal cultures and (ii) nasal versus axillary plus (where available) umbilical cultures for the detection of MRSA carriage.Northwestern Memorial Hospital is a 720-bed teaching hospital with a 46-bed NICU that admits approximately 700 infants each year. An outbreak of MRSA in this NICU was first recognized in July 2001 after it was initially recovered from an endotracheal tube specimen. Subsequently, weekly surveillance cultures for MRSA colonization were obtained from the anterior nares and rectum of all neonates with sterile rayon-tip swabs (Culturette, BBL, Sparks, Md.). Samples were plated directly onto mannitol salt agar and incubated at 35°C for 48 h. Mannitol-fermenting colonies were subcultured onto 5% sheep blood agar plates. S. aureus was identified by a latex agglutination test (Pastorex Staph Plus, Sanofi Diagnostic Pasteur, Marnes La Coquette, France). S. aureus isolates for which the oxacillin MIC was Ն4 g/ml by the agar dilution technique were classified as MRSA (11).Evanston Northwestern Healthcare is an 804-bed primary and tertiary referral center with a 44-bed NICU that admits approximately 520 infants each year. An outbreak of MRSA here was first recognized in October 2001 after MRSA was recovered from the endotracheal tube and blood of a neonate. Weekly surveillance cultures for the detection of MRSA were obtained from the anterior nares and rectum from all neonates in the NICU. In December 2001, following an interim comparison between paired nasal and rectal swabs, it was decided to discontinue rectal cultures. Continued comparisons were performed between paired nasal and axillary cultures plus (where present) umbilical stump cultures. All cultures were plated directly onto Columbia-colistin-nalidixic acid-5% sheep blood agar plates (Remel, Inc., Lenexa, Kans.) and incubated at 35°C for 48 h. Isolates ...