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Changes in the Molecular Epidemiological Characteristics of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

  • Alison J. Carey (a1), Phyllis Della-Latta (a2) (a3), Richard Huard (a2) (a3), Fann Wu (a2) (a3), Phillip L. Graham (a4) (a5) (a6), Diane Carp (a6) and Lisa Saiman (a4) (a5) (a6)...

Extract

Objective.

To determine whether the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus (MRSA) had changed in a level III neonatal intensive care unit (NICU).

Design.

Retrospective review of medical records.

Setting.

Level III NICU of a university-affiliated children's hospital in New York, New York.

Patients.

Case patients were neonates hospitalized in the NICU who were colonized or infected with MRSA.

Methods.

Rates of colonization and infection with MRSA during the period from 2000 through 2008 were assessed. Staphylococcal chromosomal cassette (SCC) mecA analysis and genotyping for S. aureus encoding protein A (spa) were performed on representative MRSA isolates from each clonal pulsed-field gel electrophoresis pattern.

Results.

Endemic MRSA infection and colonization occurred throughout the study period, which was punctuated by 4 epidemiologic investigations during outbreak periods. During the study period, 93 neonates were infected and 167 were colonized with MRSA. Surveillance cultures were performed for 1,336 neonates during outbreak investigations, and 115 (8.6%) neonates had MRSA-positive culture results. During 2001-2004, healthcare-associated MRSA clones, carrying SCC mec type II, predominated. From 2005 on, most MRSA clones were community-associated MRSA with SCC mec type IV, and in 2007, USA300 emerged as the principal clone.

Conclusions.

Molecular analysis demonstrated a shift from healthcare-associated MRSA (2001-2004) to community-associated MRSA (2005-2008).

Copyright

Corresponding author

Division of Neonatology, St. Christopher's Hospital for Children, 3601 A Street, Philadelphia, PA 19134, (alison.carey@drexelmed.edu)

References

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1.Banerjee, SN, Grohskopf, LA, Sinkowitz-Cochran, RL, Jarvis, WR. Incidence of pediatric and neonatal intensive care unit-acquired infections. Infect Control Hosp Epidemiol 2006;27:561570.
2.Baltimore, RS. Neonatal nosocomial infections. Semin Perinatol 1998;22: 2532.
3.Stoll, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285291.
4.Seybold, U, Halvosa, JS, White, N, Voris, V, Ray, SM, Blumberg, HM. Emergence of and risk factors for methicillin-resistant Staphylococcus aureus of community origin in intensive care nurseries. Pediatrics 2008; 122: 10391046.
5.McAdams, RM, Ellis, MW, Trevino, S, Rajnik, M. Spread of methicillin-resistant Staphylococcus aureus USA300 in a neonatal intensive care unit. Pediatr Int 2008;50:810815.
6.Bertin, ML, Vinski, J, Schmitt, S, et al.Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 2006;27:581585.
7.Saiman, L, Cronquist, A, Wu, F, et al.An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317321.
8.Carey, AJ, Duchon, J, Delia-Latta, P, Saiman, L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000-2007. J Perinatol 2010;30:135139.
9.Gonzalez, BE, Martinez-Aguilar, G, Hulten, KG, et al.Severe staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatrics 2005;115:642648.
10.Miller, LG, Perdreau-Remington, F, Rieg, G, et al.Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352:14451453.
11.Chen, KT, Huard, RC, Delia-Latta, P, Saiman, L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006;108:482487.
12.Andrews, WW, Schelonka, R, Waites, K, Stamm, A, Cliver, SP, Moser, S. Genital tract methicillin-resistant Staphylococcus aureus: risk of vertical transmission in pregnant women. Obstet Gynecol 2008;111:113118.
13.Saiman, L, O'Keefe, M, Graham, PL III, et al.Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003;37:13131319.
14.Roberts, RB, de Lencastre, A, Eisner, W, et al.Molecular epidemiology of methicillin-resistant Staphylococcus aureus in 12 New York hospitals. J Infect Dis 1998;178:164171.
15.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
16.Koreen, L, Ramaswamy, SV, Graviss, EA, Naidich, S, Musser, JM, Kreiswirth, BN. spa typing method for discriminating among Staphylococcus aureus isolates: implications for use of a single marker to detect genetic micro-and macrovariation. J Clin Microbiol 2004;42:792799.
17.Lina, G, Piemont, Y, Godail-Gamot, F, et al.Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:11281132.
18.McDonald, RR, Antonishyn, NA, Hansen, T, et al.Development of a triplex real-time PCR assay for detection of Panton-Valentine leukocidin toxin genes in clinical isolates of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:61476149.
19.Zhang, K, McClure, JA, Elsayed, S, Louie, T, Conly, JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:50265033.
20.Oliveira, DC, de Lencastre, H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimtcrob Agents Chemother 2002; 46:21552161.
21.Haas, J, Larson, E, Ross, B, See, B, Saiman, L. Epidemiology and diagnosis of hospital-acquired conjunctivitis among neonatal intensive care unit patients. Pediatr Infect Dis J 2005;24:586589.
22.Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests-approved standard. 10th ed. CLSI document M2-A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
23.Clinical and Laboratory Standards Institute (CLSI). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically-approved standard. 8th ed. CLSI document M7-A8. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
24.Healy, CM, Hulten, KG, Palazzi, DL, Campbell, JR, Baker, CJ. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004;39:14601466.
25.David, MD, Kearns, AM, Gossain, S, Ganner, M, Holmes, A. Community-associated methicillin-resistant Staphylococcus aureus: nosocomial transmission in a neonatal unit. J Hosp Infect 2006;64:244250.
26.Gastelum, DT, Dassey, D, Mascola, L, Yasuda, LM. Transmission of community-associated methicillin-resistant Staphylococcus aureus from breast milk in the neonatal intensive care unit. Pediatr Infect Dis J 2005; 24:11221124.
27.Al-Tawfiq, JA. Father-to-infant transmission of community-acquired methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2006;27:636637.
28.Watson, J, Jones, RC, Cortes, C, et al.Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns-Chicago and Los Angeles County, 2004. MMWR Morb Mortal Wkly Rep 2006;55:329332.
29.Fortunov, RM, Hulten, KG, Hammerman, WA, Mason, EO Jr, Kaplan, SL. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006;118:874881.
30.Cannon, JGA, Perlman, J, DeLaMora, P, et al.Transmission of USA-300 methicillin-resistant Staphylococcus aureus in a newborn nursery also affecting post-partum women. In: Abstracts of the 18th Annual Meeting of the Society for Healthcare Epidemiology of America. Arlington, VA: Society for Healthcare Epidemiology of America; 2008. Abstract 178.
31.Bratu, S, Eramo, A, Kopec, R, et al.Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis 2005;11:808813.
32.Gerber, SI, Jones, RC, Scott, MV, et al.Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006;27:139145.
33.Lepelletier, D, Corvee, S, Caillon, J, Reynaud, A, Roze, JC, Gras-Leguen, C. Eradication of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: which measures for which success? Am J Infect Control 2009;37:195200.
34.Stein, M, Navon-Venezia, S, Chmelnitsky, I, et al.An outbreak of new, nonmultidrug-resistant, methicillin-resistant Staphylococcus aureus strain (SCCmec type IIIA variant-1) in the neonatal intensive care unit transmitted by a staff member. Pediatr Infect Dis J 2006;25:557559.
35.Grant, PS, Charns, LG, Rawot, BW, Benedetti, SG. Consideration to culture health care workers related to increased methicillin-resistant Staphylococcus aureus activity in a neonatal intensive care unit. Am J Infect Control 2008;36:638643.
36.Calfee, DP, Saigado, CD, Classen, D, et al.Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S62S80.
37.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10suppl 2):S165S193.
38.Huang, YC, Chou, YH, Su, LH, Lien, RI, Lin, TY. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics 2006;118:469474.
39.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36: 281285.
40.Schultz, ED, Tanaka, DT, Goldberg, RN, Benjamin, DK Jr, Smith, PB. Effect of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit on total hospital cost. Infect Control Hosp Epidemiol 2009;30:383385.

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