Journal
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
Volume 37, Issue 4, Pages 381-387Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/ice.2015.316
Keywords
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Funding
- National Institute of Allergy and Infectious Disease, National Institutes of Health [R03AI117169]
- Agency for Healthcare Research and Quality [R01HS022872]
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases of the Johns Hopkins University School of Medicine
- National Center for Research Resources, a component of the National Institutes of Health [UL1 RR 025005]
- National Institutes of Health Roadmap for Medical Research
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BACKGROUND. Staphylococcus aureus is a common cause of healthcare-associated infections in neonates. objective. To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. METHODS. We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models. RESULTS. Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected. CONCLUSION. Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
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