Skip to main content

Risk Factors for Neonatal Methicillin-Resistant Staphylococcus aureus Infection in a Well-Infant Nursery

  • Dao M. Nguyen (a1), Elizabeth Bancroft (a2), Laurene Mascola (a2), Ramon Guevara (a2) and Lori Yasuda (a2)...

To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery.


Case-control studies.


A well-infant nursery in a nonteaching, community hospital.


Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis.


Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak 1, case infants (n = 6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P = .01). In outbreak 2, case infants (n = 5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114).


Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.

Corresponding author
276 International Circle, First Floor, Module C, San Jose, CA 95119 (
Hide All
1.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.
2.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.
3.Rush, J. Does routine newborn bathing reduce Staphylococcus aureus colonization rates? A randomized controlled trial. Birth 1986;13:176180.
4.Rush, J, Fiorino-Chiovitti, R, Kaufman, K, Mitchell, A. A randomized controlled trial of a nursery ritual: wearing cover gowns to care for healthy newborns. Birth 1990;17:2530.
5.Stranko, J, Ryan, ME, Bowman, AM. Impetigo in newborn infants associated with a plastic bell clamp circumcision. Pediatr Infect Dis J 1986;5:597599.
6.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.
7.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:51135120.
8.Centers for Disease Control and Prevention, Atlanta, GA, and US Department of Health and Human Services, CDC. 2004. Epi Info version 3.3, released October 5, 2004. Available at: Accessed December 1, 2004.
9.Centers for Disease Control and Prevention. Public health dispatch: outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections—Los Angeles County, California, 2002-2003. MMWR Morb Mortal Wkly Rep 2003;52:88.
10. Community-Associated Methicillin-Resistant Staphylococcus aureus. Los Angeles County Department of Health Services' Web Information Page. Available at: Accessed December 1, 2004.
11.Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:11821189.
12.Oie, S, Kamiya, A. Survival of methicillin-resistant Staphylococcus aureus (MRSA) on naturally contaminated dry mops. J Hosp Infect 1996;34:145149.
13.Dietze, B, Rath, A, Wendt, C, Martiny, H. Survival of MRSA on sterile goods packaging [review]. J Hosp Infect 2001;49:255261.
14.Fujimura, S, Kato, S, Hashimoto, M, Takeda, H, Maki, F, Watanabe, A. Survey of methicillin-resistant Staphylococcus aureus from neonates and the environment in the NICU. J Infect Chemother 2004;10:131132.
15.Sinha, A, Yokoe, D, Platt, R. Epidemiology of neonatal infections: experience during and after hospitalization. Pediatr Infect Dis J 2003;22:244251.
16.Saiman, L, O'Keefe, M, Graham, PL IIIet al.Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003;37:13131319.
17.King, MD, Humphrey, BJ, Wang, YF, Kourbatova, EV, Ray, SM, Blumberg, HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006;144:309317.
18.Laibl, VR, Sheffield, JS, Roberts, S, McIntire, DD, Trevino, S, Wendel, GD JrClinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. Obstet Gynecol 2005;106:461465.
19. Information About MRSA for Healthcare Personnel. Centers for Disease Control and Prevention Web Information Page. Available at: Accessed September 4, 2004.
20.Stark, V. Harrison, SP. Staphylococcus aureus colonization of the newborn in a Darlington hospital. J Hosp Infect 1992;21:205211.
21.Hargiss, C, Larson, E. The epidemiology of Staphylococcus aureus in a newborn nursery from 1970 through 1976. Pediatrics 1978;61:348353.
22.Kuehnert, MJ, Kruszon-Moran, D, Hill, HA, et al.Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006;193:172179.
23.Kitajima, H. Prevention of methicillin-resistant Staphylococcus aureus infections in neonates. Pediatr Int 2003;45:238245.
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? *


Altmetric attention score

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