Healthcare-associated infections (HAIs) are responsible for significant morbidity and mortality in hospitalized neonates. Staphylococcus aureus (S. aureus) is the second most common cause of healthcare associated infections in neonates. Current recommendations to prevent S. aureus disease in the NICU have focused on MRSA prevention and have overlooked potentially preventable methicillin-susceptible S. aureus (MSSA) disease. Our objectives were to examine the impact of MSSA decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance in a level IIIC NICU.
We retrospectively identified neonates admitted to our NICU between April 1 2011 and September 30 2014. We compared rates of MSSA-positive cultures and infections before and after implementation (on April 1 2013) of an active surveillance cultures and decolonization intervention for MSSA-colonized neonates. Primary outcomes were NICU-attributable MSSA: 1) any culture sent during routine clinical care that grew MSSA and 2) NICU-attributable NHSN-defined MSSA infections. S. aureus isolates were tested for mupirocin susceptibility. To determine the impact of the intervention on MSSA infection, we estimated incidence rate ratios using interrupted time series models.
Pre- and post-intervention, 1523 neonates (29,220 patient-days) and 1195 neonates (22,045 patient-days) respectively, were admitted to the NICU. Post-intervention, mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures decreased immediately by more than 60% (IRR=0.36, 95% CI 0.19, 0.70) and continued to decrease (IRR 0.79 95% CI 0.74, 0.84). MSSA infections also decreased post-intervention (IRR 0.30 95% CI 0.10, 0.96).
Our findings suggest that decolonization may be effective in decreasing the burden of S. aureus in NICUs and should not be limited to MRSA colonized neonates.
V. O. Popoola,
N. Suwantarat, None
K. C. Carroll, None
S. W. Aucott, None
A. M. Milstone, Sage Products LLC: Grant Investigator , Research grant