Skip to main content
×
×
Home

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

  • Matthew C. Washam (a1), Andrea Ankrum (a2), Beth E. Haberman (a3), Mary Allen Staat (a4) and David B. Haslam (a4)...
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

Copyright
Corresponding author
Address correspondence to Matthew Washam, MD MPH, 1600 SW Archer Rd, Gainesville, FL 32610 (mwasham@ufl.edu).
References
Hide All
1. Polin, RA, Denson, S, Brady, MT , Committee on F, Newborn, Committee on Infectious D. Epidemiology and diagnosis of health care–associated infections in the NICU. Pediatrics 2012;129:e1104e1109.
2. Clark, R, Powers, R, White, R, Bloom, B, Sanchez, P, Benjamin, DK Jr. Nosocomial infection in the NICU: a medical complication or unavoidable problem? J Perinatol 2004;24:382388.
3. Polin, RA, Denson, S, Brady, MT , Committee on F, Newborn, Committee on Infectious D. Strategies for prevention of health care-associated infections in the NICU. Pediatrics 2012;129:e1085e1093.
4. Patrick, SW, Kawai, AT, Kleinman, K, et al. Health care-associated infections among critically ill children in the US, 2007–2012. Pediatrics 2014;134:705712.
5. Ericson, JE, Popoola, VO, Smith, PB, et al. Burden of invasive Staphylococcus aureus infections in hospitalized infants. JAMA Pediatr 2015;169:11051111.
6. Gordon, RJ, Lowy, FD. Pathogenesis of methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46(Suppl 5):S350S359.
7. Zervou, FN, Zacharioudakis, IM, Ziakas, PD, Mylonakis, E. MRSA colonization and risk of infection in the neonatal and pediatric ICU: a meta-analysis. Pediatrics 2014;133:e1015e1023.
8. Song, X, Perencevich, E, Campos, J, Short, BL, Singh, N. Clinical and economic impact of methicillin-resistant Staphylococcus aureus colonization or infection on neonates in intensive care units. Infect Control Hosp Epidemiol 2010;31:177182.
9. Katsuse Kanayama, A, Takahashi, H, Yoshizawa, S, Tateda, K, Kaneko, A, Kobayashi, I. Staphylococcus aureus surface contamination of mobile phones and presence of genetically identical strains on the hands of nursing personnel. Am J Infect Control 2017;45:929931.
10. Rampling, A, Wiseman, S, Davis, L, et al. Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus . J Hosp Infect 2001;49:109116.
11. Popoola, VO, Budd, A, Wittig, SM, et al. Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention. Infect Control Hosp Epidemiol 2014;35:412418.
12. Coughenour, C, Stevens, V, Stetzenbach, LD. An evaluation of methicillin-resistant Staphylococcus aureus survival on five environmental surfaces. Microb Drug Resist 2011;17:457461.
13. Song, X, Cheung, S, Klontz, K, Short, B, Campos, J, Singh, N. A stepwise approach to control an outbreak and ongoing transmission of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Infect Control 2010;38:607611.
14. 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.
15. Price, EH, Brain, A, Dickson, JA. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect 1980;1:221228.
16. Geraci, DM, Giuffre, M, Bonura, C, et al. Methicillin-resistant Staphylococcus aureus colonization: a three-year prospective study in a neonatal intensive care unit in Italy. PloS One 2014;9:e87760.
17. Geva, A, Wright, SB, Baldini, LM, Smallcomb, JA, Safran, C, Gray, JE. spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: network analysis. Pediatrics 2011;128:E1173E1180.
18. Lazenby, GB, Soper, DE, Beardsley, W, Salgado, CD. Methicillin-resistant Staphylococcus aureus colonization among women admitted for preterm delivery. Am J Obstet Gynecol 2012;206:329.e1e5. doi: 10.1016/j.ajog.2012.01.038.
19. Kuo, CY, Huang, YC, Huang, DTN, et al. Prevalence and molecular characterization of Staphylococcus aureus colonization among neonatal intensive care units in Taiwan. Neonatology 2014;105:142148.
20. 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.
21. Hornik, CP, Fort, P, Clark, RH, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Human Devel 2012;88(Suppl 2):S69S74.
22. Washam, M, Woltmann, J, Haberman, B, Haslam, D, Staat, MA. Risk factors for MRSA colonization in the neonatal ICU: A systematic review and meta-analysis. Am J Infect Control 2017 (in press).
23. Graham, PL 3rd, Morel, AS, Zhou, J, et al. Epidemiology of methicillin-susceptible Staphylococcus aureus in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2002;23:677682.
24. Carey, AJ, Duchon, J, Della-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.
25. Romaniszyn, D, Rozanska, A, Wojkowska-Mach, J, et al. Epidemiology, antibiotic consumption and molecular characterisation of Staphylococcus aureus infections—data from the Polish Neonatology Surveillance Network, 2009-2012. BMC Infect Dis 2015;15:169. doi: 10.1186/s12879-015-0890-3.
26. Dolapo, O, Dhanireddy, R, Talati, AJ. Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000–2009. BMC Pediatr 2014;14:121. doi: 10.1186/1471-2431-14-121.
27. Romano-Bertrand, S, Filleron, A, Mesnage, R, et al. Staphylococcus aureus in a neonatal care center: methicillin-susceptible strains should be a main concern. Antimicrob Resist Infect Control 2014;3:21.
28. Delgadorodriguez, M, Buenocavanillas, A, Lopezgigosos, R, et al. Hospital stay length as an effect modifier of other risk-factors for nosocomial infection. Eur J Epidemiol 1990;6:3439.
29. Freeman, J, Mcgowan, JE. Risk-factors for nosocomial infection. J Infect Dis 1978;138:811819.
30. Maraqa, NF, Aigbivbalu, L, Masnita-Iusan, C, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control 2011;39:3541.
31. Kaye, KS, Harris, AD, Samore, M, Carmeli, Y. The case-case-control study design: addressing the limitations of risk factor studies for antimicrobial resistance. Infect Control Hosp Epidemiol 2005;26:346351.
32. Popoola, VO, Carroll, KC, Ross, T, Reich, NG, Perl, TM, Milstone, AM. Impact of colonization pressure and strain type on methicillin-resistant Staphylococcus aureus transmission in children. Clin Infect Dis 2013;57:14581460.
33. Giuffre, M, Bonura, C, Cipolla, D, Mammina, C. MRSA infection in the neonatal intensive care unit. Expert Rev Anti-infect Ther 2013;11:499509.
34. Julian, S, Burnham, CA, Sellenriek, P, et al. Impact of neonatal intensive care bed configuration on rates of late-onset bacterial sepsis and methicillin-resistant Staphylococcus aureus colonization. Infect Control Hosp Epidemiol 2015;36:11731182.
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

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