Clinical Outcomes in Methicillin-Resistant <i>Staphylococcus aureus-</i>Colonized Neonates in the Neonatal Intensive Care Unit

Abstract

Background: Methicillin-resistent Staphylococcus aureus (MRSA) colonization can persist for prolonged periods, and patient-related factors are associated with persistent carriage in adults. However, such knowledge is lacking among neonates. Objectives: To better understand the outcome of MRSA-colonized neonates in the neonatal intensive care unit (NICU), we prospectively followed all colonized neonates until decolonization over 39 months and determined the incidence, duration of colonization, clinical outcomes and risk factors associated with prolonged carriage of MRSA. Methods: Nasal and inguinal cultures were obtained from all newly admitted neonates following an outbreak of MRSA. Weekly and 1–2 monthly cultures were obtained from all hospitalized and discharged neonates colonized with MRSA, respectively, until 2 consecutive cultures were negative. Results: 152 of 1,456 (10.4%) neonates became colonized. The mean time to acquire MRSA colonization was 17.1 ± 40.7 (range 1–471) days. The median time to decolonization was 36 days. About 20% of decolonized patients had been colonized for a prolonged period of ≧160 days. 47.5% of colonized patients were sent home colonized, and none with prolonged carriage developed MRSA-related infections in the following 6 months in contrast to 6 infants (3.9%) who developed MRSA sepsis during hospitalization. The only risk factor associated with prolonged carriage was the concurrent colonization of both the inguinal and nasal areas on admission. Conclusion:Nearly all neonates with acquired colonization became decolonized either prior to or after discharge from NICU. A significant percentage failed to decolonize prior to hospital discharge, but almost all decolonized by 30 months in the community without evidence of systemic or local infections.

Outbreak of Gram-positive bacterial keratitis associated with epidemic keratoconjunctivitis in neonates and infants

“…In fact, there is a report that 10.4% of neonates in an NICU of Korea became usually colonized with MRSA and they could acquire MRSA colonization in a day (mean: 17days, range: 1-471 days). 16 However, in our study, the mean colonization rate of the conjunctiva and other parts of body were 53 and 48.5% at that time, respectively. This higher colonization rate might be a possible contributing factor for MRSA-associated bacterial keratitis development.…”

“…A significant percentage fails to decolonize before hospital discharge after 30 months. 16 Our present study demonstrated that healthy neonates who had been discharged from the nursery 2 days after birth also developed MRSA keratitis after discharge. Considering the fact that the colonization can be established even with 1 day of HCU stay, it is quite possible that healthy neonates with EKC are at a higher risk for the Table 2 Characteristics of the patients who showed bacterial keratitis associated with EKC Patient no.…”

MRSA Colonization and Risk of Infection in the Neonatal and Pediatric ICU: A Meta-analysis

“…Three of 18 eligible studies subgrouped their population into inborn and outborn and reported stratified data on 2726 inborns and 990 outborns. 31,38,41 Interestingly, the prevalence of MRSA colonization among outborn neonates was 5.8% (95% CI 1.9%-11.4%), compared with just 0.2% (95% CI 0.0%-0.9%) among inborn Time was from admission to screening, n was the evaluable sample. Data stratified by location (Europe, North America, Asia) and midyear of each study.…”

“…Eight studies provided data on the acquisition of MRSA during the ICU stay. 26,27,29,32,36,38,39,41 The acquisition rate was 4.1% (95% CI 1.2%-8.6%) among the neonatal and pediatric population, whereas among the neonatal population alone, 6.1% (95% CI 2.8%-10.6%) of patients acquired MRSA during the NICU stay. The pooled acquisition rate for the PICU population alone was not calculated because of insufficient data reporting (2 studies).…”

“…[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] The studies provided screening data on 19 722 neonatal and pediatric patients. More specifically, 11 studies reported data on 12 284 screened neonates in 12 NICUs, whereas 6 studies reported data on 7107 children hospitalized in 6 PICUs.…”