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Risk Factors for Staphylococcus aureus Acquisition in the Neonatal Intensive Care Unit: A Matched Case-Case-Control Study

Published online by Cambridge University Press:  21 November 2017

Matthew C. Washam ,
Andrea Ankrum ,
Beth E. Haberman ,
Mary Allen Staat  and
David B. Haslam
Matthew C. Washam*
Affiliation:
Shands Children’s Hospital, University of Florida Health, Gainesville, Florida
Andrea Ankrum
Affiliation:
Infection Control Program, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Beth E. Haberman
Affiliation:
Division of Neonatology and Pulmonary Biology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Mary Allen Staat
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
David B. Haslam
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
*
Address correspondence to Matthew Washam, MD MPH, 1600 SW Archer Rd, Gainesville, FL 32610 (mwasham@ufl.edu).
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Abstract

OBJECTIVE

To determine risk factors independent of length of stay (LOS) for Staphylococcus aureus acquisition in infants admitted to the neonatal intensive care unit (NICU).

DESIGN

Retrospective matched case–case-control study.

SETTING

Quaternary-care referral NICU at a large academic children’s hospital.

METHODS

Infants admitted between January 2014 and March 2016 at a level IV NICU who acquired methicillin resistant (MRSA) or susceptible (MSSA) S. aureus were matched with controls by duration of exposure to determine risk factors for acquisition. A secondary post hoc analysis was performed on the entire cohort of at-risk infants for risk factors identified in the primary analysis to further quantify risk.

RESULTS

In total, 1,751 infants were admitted during the study period with 199 infants identified as having S. aureus prevalent on admission. There were 246 incident S. aureus acquisitions in the remaining at-risk infant cohort. On matched analysis, infants housed in a single-bed unit were associated with a significantly decreased risk of both MRSA (P=.03) and MSSA (P=.01) acquisition compared with infants housed in multibed pods. Across the entire cohort, pooled S. aureus acquisition was significantly lower in infants housed in single-bed units (hazard ratio,=0.46; confidence interval, 0.34–0.62).

CONCLUSIONS

NICU bed design is significantly associated with S. aureus acquisition in hospitalized infants independent of LOS.

Infect Control Hosp Epidemiol 2018;39:46–52

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 46 - 52
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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