296. Optimum Frequency of Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance Screening in the Neonatal Intensive Care Unit (NICU)
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • NICU MRSA IDWeek Poster 2013-9-17.pdf (610.3 kB)
  • Background:

    Routine active surveillance for MRSA is increasingly used as a strategy to identify and isolate colonized infants and to limit the spread of MRSA in NICU. The optimal frequency of surveillance testing for MRSA in NICU has not been determined.

    Methods:

    Between 2004 & 2009, we performed weekly MRSA screening of all infants admitted to our level III NICU until they became MRSA colonized or infected or were discharged. Any MRSA colonized or infected infant was isolated, cohorted, and no longer screened until discharge. Infection control measures (cohorting, isolation, nasal mupirocin, hand hygiene & limited visitations) were applied uniformly and the occupancy of the NICU remained at a constant rate during the entire study period.

    We developed a prediction model for parameters of gender, ethnicity, gestational age (GA), birthweight (BW) and mode of delivery for our NICU infants to determine the probability of MRSA colonization by week of surveillance testing.

    Results:

    Of 4004 infants that were admitted to NICU & included in our 6-year analysis, 2241 (56%) were male, 2802 (70%) were White, & 2396 (60%) were delivered by caesarean section (C/S). Mean BW was 2.4Kg (median 2.4, range: 0.3-5.9), mean GA was 34.5 weeks (35, 22-42) & mean length of stay was 2.4 days (13, 1-273). Prevalence of MRSA colonization was 3.62/1000 patient days (95% CI: 2.88, 3.59). There were 317 (7.9%) MRSA colonized infants. Non-whites (RR 1.36; 95% CI: 1.10, 1.70; P=0.005) & C/S delivered infants (RR 1.81; 95% CI: 1.43, 2.31; P<0.0001) had a higher risk of colonization. Colonized infants had 3.17 weeks shorter GA, 0.69 Kg lower BW & 30 days longer NICU stay than the non-colonized (P< 0.0001 for each).

    The probability of colonization for GA ≤23, 28, 33 & ≥41 weeks at week 1 testing was 0.9, 0.58, 0.35 & 0.18, respectively. At week 2 testing, probability was 0.03, 0.02, 0.01 & 0.007, respectively. By week 3 testing, the probability of colonization dropped to <0.001 for GA ≤23 weeks & <0.0005 for all other GA.

    Conclusion:

    Our data suggest that weekly, universal MRSA screening is important in detecting colonized infants in NICU; however, the probability of being colonized drops significantly after the second week testing for all infants regardless of gestational age or weight at birth. 

    In NICU, we recommend weekly MRSA surveillance for only the first two weeks of hospitalization.

    Nizar Maraqa, MD1, Sarah Wheeler, ARNP, MPH1, Christine Bailey, BSN, MSH2, Ryan Butterfield, MPH3, Dale Kraemer, PhD3 and Mobeen Rathore, MD2,4, (1)Pediatric Infectious Diseases and Immunology, University of Florida College of Medicine- Jacksonville, Jacksonville, FL, (2)Epidemiology and Infection Control, Wolfson Children's Hospital, Jacksonville, FL, (3)University of Florida Center for Health Equity and Quality Research, Jacksonville, FL, (4)University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES)- Jacksonville, Jacksonville, FL

    Disclosures:

    N. Maraqa, None

    S. Wheeler, None

    C. Bailey, None

    R. Butterfield, None

    D. Kraemer, None

    M. Rathore, None

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