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Epidemiology of Methicillin-Susceptible Staphylococcus Aureus in the Neonatal Intensive Care Unit

  • Philip L. Graham (a1), Anne-Sophie Morel (a1), Juyan Zhou (a1), Fann Wu (a2), Phyllis Della-Latta (a2), David Rubenstein (a1) and Lisa Saiman (a1) (a3)...

When the incidence of methicillin-susceptible Staphylococcus aureus (MSSA) infection or colonization increased in our neonatal intensive care unit (NICU), we sought to further our understanding of the relationship among colonization with MSSA, endemic infection, and clonal spread.


A retrospective cohort study was used to determine risk factors for acquisition of a predominant clone of MSSA (clone “B”).


A 45-bed, university-affiliated, level III-IV NICU.


Infants hospitalized in the NICU from October 1999 to September 2000.


Infection control strategies included surveillance cultures of infants, cohorting infected or colonized infants, contact precautions, universal glove use, mupirocin treatment of the anterior nares of all infants in the NICU, and a hexachlorophene bath for infants weighing 1,500 g or more.


During the 1-year study period, three periods of increased incidence of MSSA colonization or infection, ranging from 6.4 to 13.5 cases per 1,000 patient-days per month, were observed. Molecular typing using pulsed-field gel electrophoresis demonstrated two predominant clones, clone “B” and clone “G,” corresponding to two periods of increased incidence. Multivariate analysis demonstrated that length of stay (OR, 1.035; 95% confidence interval [CI95], 1.008 to 1.062; P = .010) (increased risk per day) and the use of H2-blockers (OR, 20.44; CI95, 2.48 to 168.26; P = .005) were risk factors for either colonization or infection with clone “B,” and that the use of peripheral catheters was protective (OR, 0.06; CI95, 0.01 to 0.43; P = .005).


Control of MSSA represents unique challenges as colonization is expected, endemic infections are tolerated, and surveillance efforts generally focus on multidrug-resistant pathogens. Future studies should address cost-effective surveillance strategies for endemic infections.

Corresponding author
Department of Pediatrics, Columbia University, 622 W. 168th St., PH 4 West Rm. 470 New York, NY 10032
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1. EF La Gamma , LM Drusin , AW Mackles , S Machalek , PA Auld . Neonatal infections: an important determinant of late NICU mortality in infants less than 1,000g at birth. American Journal of Diseases in Children 1983;137:838841.

3. BJ Stoll , T Gordon , SB Korones , et al. Late onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:6371.

4. Q Haddad . E Sobayo , OBA Basit , VO Rotimi . Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Hosp Infect 1993;23:211222.

7. JR Campbell , E Zaccaria , EO Mason Jr, CJ Baker . Epidemiological analysis defining concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1998;19:924928.

10. MN Chowdhury , AM Kambal . An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit. J Hosp Infect 1992;22:299305.

11. M Eriksson , B Melen , KE Myrback , B Winbladh , R Zetterstrom . Bacterial colonization of newborn infants in a neonatal intensive care unit. Acta Paediatr Scand 1982;71:779783.

13. AS Morel , F Wu , P Della-Latta , A Cronquist , D Rubenstein , L Saiman . “Nosocomial” transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants. Am J Infect Control 2002;30:170173.

21. F Lowy . Staphylococcus aureus infections. N Engl J Med 1998;339:520532.

22. X Corbella , MA Dominguez , M Pujol , et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16:351357.

23. C Von Eiff , K Becker , K Machka , H Stammer , G Peters . Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001; 344:1116.

25. P Villari , L Iacuzio , I Torre , A Scarcella . Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit. J Infect 1998;37:274281.

26. JY Kawagoe , CA Segre , CR Pereira , MF Cardoso , CV Silva , JT Fukushima . Risk factors for nosocomial infections in critically ill newborns: a 5-year prospective cohort study. Am J Infect Control 2001;29:109114.

27. M Driks , D Craven , B Celli , et al. Nosocomial pneumonia in intubated patients given sulcralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 1987;317:13761382.

28. C Beck-Sague , P Azimi , S Fonseca , et al. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J 1994;13:11101116.

29. L Saiman , E Ludington , M Pfaller , et al. Risk factors for candidemia in neonatal intensive care unit patients. Pediatr Infect Dis J 2001;20:11191124.

31. J Weber , K Angstwurm , T Rosenkranz , et al. Histamine (H1) receptor antagonist inhibits leukocyte rolling in pial vessels in the early phase of bacterial meningitis in rats. Neurosci Lett 1997;226:1720.

32. L Finelli , JR Livengood , L Saiman . Surveillance of pharyngeal colonization: detection and control of serious bacterial illness in low birth weight infants. Pediatr Infect Dis J 1994;13:854359.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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