Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible <b><i>Staphylococcus aureus</i></b> Infections in VLBW Infants

Abstract

Background: Methicillin-susceptible Staphylococcus aureus (MSSA) is a major contributor to infectious episodes of very low birth weight infants (VLBWI), resulting in significant morbidity and mortality. Objective: To examine the efficacy and safety of surveillance cultures and the decolonization of MSSA-colonized VLBWI. Methods: VLBWI admitted to our neonatal wards in 2011-2016 were retrospectively analyzed. Rates of MSSA-attributable infections were compared before and after the implementation of active surveillance cultures and the decolonization of MSSA-colonized patients. The mupirocin susceptibility of isolated MSSA strains was routinely tested. Results: A total of 1,056 VLBWI were included in the study, 552 in the pre-intervention period and 504 in the post-intervention period. The implementation of surveillance cultures and decolonization of colonized patients resulted in a 50% reduction of incidence rates per 1,000 patient-days of MSSA-attributable infections (1.63 [95% CI 1.12-2.31] vs. 0.83 [95% CI 0.47-1.35], p = 0.024). No adverse effects were observed from application of the decolonization protocol with mupirocin and octenidin. No mupirocin-resistant MSSA strains were detected during the study period. Conclusion: Implementation of an active surveillance and decolonization protocol resulted in a reduction of MSSA-attributable infections in VLBWI.

Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU

“…This supports prior suggestions that decolonization regimens may attenuate nasal bioburden rather eradicate S. aureus . 14,17,31 Additionally, extra-nasal sites of endogenous colonization may contribute to recurrent colonization. However, many hospitals perform nasal surveillance without testing other anatomic sites, as the nares remain the principal reservoirs for S. aureus and elimination of nasal carriage has been associated with decreased incidence of infections.…”

“…2,9 Active surveillance cultures (ASC) and decolonization of colonized neonates have led to reduced rates of S. aureus transmission and infections 10–13 , an approach that benefits the vulnerable neonate and concurrently, the general NICU population. 11,14 …”

“…healthcare workers, contaminated surfaces, parents) or may be as a result of antimicrobial resistance. 14,18,19 There are no available data describing which factors may impact the risk of recurrent S. aureus colonization in neonates. Our objectives were to identify neonatal risk factors associated with recurrent S. aureus colonization after decolonization and to examine the genetic relatedness of S. aureus strains before and after decolonization.…”

New Threats from an Old Foe: Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> Infections in Neonates

“…Currently, the mortality rate of MRSA infections varies widely among institutions, ranging from about 2.9 to 28% [3, 9, 19, 23]. Although there seems to be no difference between MRSA and methicillin-susceptible S. aureus in terms of their clinical presentation and mortality [3, 23, 28], neonates infected with MRSA may have a higher readmission rate and a longer infection course than MSSA cases [26, 29]. …”

Association of an Active Surveillance and Decolonization Program on Incidence of Clinical Cultures Growing Staphylococcus aureus in the Neonatal Intensive Care Unit

“…8 Emerging resistance to mupirocin must also be considered with widespread use, but recent S. aureus ASC and decolonization programs have not found an increase in resistance to mupirocin. 4–6,9 …”