Skip to main content Accessibility help
×
×
Home

Clinical and Economic Impact of Methicillin-Resistant Staphylococcus aureus Colonization or Infection on Neonates in Intensive Care Units

  • Xiaoyan Song (a1), Eli Perencevich (a2), Joseph Campos (a1), Billie L. Short (a1) and Nalini Singh (a1)...

Extract

Objective.

The rising incidence and mortality of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in children has become a great concern. This study aimed to determine the clinical and economic impact of MRSA colonization or infection on infants and to measure excess mortality, length of stay, and hospital charges attributable to MRSA.

Design.

This is a retrospective cohort study.

Setting and Patients.

The study included infants admitted to a level III-IV neonatal intensive care unit from September 1, 2004, through March 31, 2008.

Methods.

A time-dependent proportional hazard model was used to analyze the association between MRSA colonization or infection and mortality. The relationships between MRSA colonization or infection and length of stay and between MRSA colonization or infection and hospital charges were assessed using a matched cohort study design.

Results.

Of 2,280 infants, 191 (8.4%) had MRSA colonization or infection. Of 132 MRSA isolates with antibiotic susceptibility results, 106 were resistant to clindamycin and/or trimethoprim-sulfamethoxazole, thus representing a noncommunity phenotype. The mortality rate was 17.8% for patients with MRSA colonization or infection and 11.5% for control subjects. Neither MRSA colonization (hazard ratio [HR], 0.9 [95% confidence interval {CI}, 0.5-1.5]; P > .05) nor infection (HR, 1.2 [95% CI, 0.7-1.9]; P > .05) was associated with increased mortality risk. Infection caused by MRSA strains that were resistant to clindamycin and/or trimethoprim-sulfamethoxazole increased the mortality risk by 40% (HR, 1.4 [95% CI, 0.9-2.2]; P > .05), compared with the mortality risk of control subjects, but the increase was not statistically significant. MRSA infection independently increased length of stay by 40 days (95% CI, 34.2—45.6; P < .001) and was associated with an extra charge of $164,301 (95% CI, $158,712-$169,889; P < .001).

Conclusions.

MRSA colonization or infection in infants is associated with significant morbidity and financial burden but is not independently associated with increased mortality.

Copyright

Corresponding author

Div of Infectious Disease, Children's National Medical Center, George Washington University Medical Center, Ste W3.5-100, ID, 111 Michigan Ave NW, Washington, DC 20010, (xsong@cnmc.org)

References

Hide All
1.Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes R; National Nosocomial Infections Surveillance System. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389391.
2.Klevens, RM, Edwards, JR, Richards, CL Jr, et al.Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122(2):160166.
3.Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns—Chicago and Los Angeles County, 2004. MMWR Morb Mortal Wkly Rep 2006;55(12):329332.
4.Hitomi, S, Kubota, M, Mori, N, et al.Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by un-selective use of nasal mupirocin ointment. J Hosp Infect 2000;46(2):123129.
5.Khoury, J, Jones, M, Grim, A, Dunne, WM Jr, Fraser, V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26(7):616621.
6.Nambiar, S, Herwaldt, LA, Singh, N. Outbreak of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med 2003;4(2):220226.
7.McDonald, JR, Carriker, CM, Pien, BC, et al.Methicillin-resistant Staphylococcus aureus outbreak in an intensive care nursery: potential for interinstitutional spread. Pediatr Infect Dis J 2007;26(8):678683.
8.Morel, AS, Wu, F, Della-Latta, P, Cronquist, A, Rubenstein, D, Saiman, L. Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants. Am J Infect Control 2002;30(3):170173.
9.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(6):636637.
10.Mean, M, Mallaret, MR, Andrini, P, et al.A neonatal specialist with recurrent methicillin-resistant Staphylococcus aureus (MRSA) carriage implicated in the transmission of MRSA to newborns. Infect Control Hosp Epidemiol 2007;28(5):625628.
11.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(6):581585.
12.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(5):317321.
13.Behari, P, Englund, J, Alcasid, G, Garcia-Houchins, S, Weber, SG. Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk. Infect Control Hosp Epidemiol 2004;25(9):778780.
14.Andersen, BM, Lindemann, R, Bergh, K, et al.Spread of methicü1in-resistant Staphylococcus aureus in a neonatal intensive unit associated with under-staffing, overcrowding and mixing of patients. J Hosp Infect 2002;50(1):1824.
15.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(Suppl 2):S82S89.
16.Lessa, FC, Edwards, JR, Fridkin, SK, Tenover, FC, Horan, TC, Gorwitz, RJ. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995-2004. Pediatr Infect Dis 2009;28(7):577581.
17.Popovich, K, Hota, B, Rice, T, Aroutcheva, A, Weinstein, RA. Phenotypic prediction rule for community-associated methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2007;45(7):22932295.
18.Newborn guidelines. In: International Classification of Diseases. Ver 9.0. Geneva, Switzerland: World Health Organization, 2009.
19.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 20O8;36(5):3O9332.
20.Harris, AD, Karchmer, TB, Carmeli, Y, Samore, MH. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 2001;32(7):10551061.
21.Wyllie, DH, Crook, DW, Peto, TE. Mortality after Staphylococcus aureus bacteraemia in two hospitals in Oxfordshire, 1997-2003: cohort study. BMJ 2006;333(7562):281.
22.Pollack, MM, Koch, MA, Bartel, DA, et al.A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000;105(5):10511057.
23.Kim, YH, et al.Clinical outcomes in methicillin-resistant Staphylococcus aurews-colonized neonates in the neonatal intensive care unit. Neonatology 2007;91(4):241247.
24.Denniston, S, Riordan, FA. Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review. J Infect 2006;53(6):387393.
25.Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureusin long-term carriers. Clin Infect Dis 2008;47(2):176181.
26.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51(2): 126132.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed