677. Emergence of Staphylococcus caprae in a Neonatal Intensive Care Unit (NICU)
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • S Caprae poster FINAL.pdf (442.3 kB)
  • Background:

    From 9/19 to11/17/15, a cluster of invasive S. caprae infections was identified in a 101-bed NICU (blood=3, peritoneal fluid=1, wound=1). This coagulase negative staphylococcus (CoNS) is an animal pathogen and uncommon cause of healthcare-acquired infections. Four isolates available for testing exhibited high-level resistance to mupirocin (MU) (defined as ≥512 μg/mL) and were identical by rep-PCR. Review of microbiology/infection control surveillance records (8/2009 to 10/2015) revealed no prior isolates. An outbreak was suspected. The first S. caprae isolate was coincident with laboratory use of MALDI-TOF for blood culture identification. We describe the emergence of S. caprae in a NICU that has used universal monthly MU prophylaxis since 12/2013.

    Methods:

    Isolates of S. caprae were prospectively identified from all patients in a children’s hospital and four affiliated community hospitals. Available archived isolates of CoNS isolated from the blood of NICU patients 1/1/14 to 9/1/15 were re-evaluated by MALDI-TOF. MU-resistance was determined by E-Test. Isolate relatedness was assessed by rep-PCR.

    Results:

    Seven additional isolates of S. caprae were identified through 5/4/16: 4 from NICU patients (blood=3, urine =1) and 3 from non-NICU patients (blood=1, ankle=1, ear=1). Twenty-one archived CoNS isolates from 19 patients were evaluated by MALDI-TOF; 6 initially identified as S. epidermidis were re-identified as S. caprae (earliest isolate from 1/23/14). All (3/3) non-NICU isolates were susceptible to MU and all systemic antibiotic tested, including oxacillin (OX), erythromycin (ERY), gentamicin (GNT). Of 10 available NICU isolates, 100% had high level MU resistance plus resistance to OX, ERY and GNT. One MU-resistant isolate also was resistant to linezolid, rifampin, and daptomycin. Rep-PCR grouped the MU-resistant NICU isolates into two primary clusters.

    Conclusion:

    S. caprae is a common pathogen in this NICU, but rarely identified in other pediatric and adult patients. A pseudo-outbreak was associated with MALDI-TOF implementation. NICU isolates are polyclonal and MU-resistant. The clinical significance of MU resistance deserves further study.

    Cullen Marshall, B.S.1, Elizabeth Ristagno, MD1, Lynette Boland, MSN CIC2, Gordon Stout, BS1, Alan Junkins, Ph.D.3, Charles Woods, MD, MS, FIDSA, FSHEA, FPIDS1 and Kristina Bryant, MD, FPIDS1, (1)Pediatrics, University of Louisville School of Medicine, Louisville, KY, (2)Kosair Children's Hospital, Louisville, KY, (3)Norton Hospital, Louisville, KY

    Disclosures:

    C. Marshall, None

    E. Ristagno, None

    L. Boland, None

    G. Stout, None

    A. Junkins, None

    C. Woods, None

    K. Bryant, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.