Background: Methicillin-susceptible Staphylococcus aureus (MSSA) is a major contributor to infectious episodes of very low birth weight infants (VLBWI), resulting in significant morbidity and mortality. Objective: To examine the efficacy and safety of surveillance cultures and the decolonization of MSSA-colonized VLBWI. Methods: VLBWI admitted to our neonatal wards in 2011-2016 were retrospectively analyzed. Rates of MSSA-attributable infections were compared before and after the implementation of active surveillance cultures and the decolonization of MSSA-colonized patients. The mupirocin susceptibility of isolated MSSA strains was routinely tested. Results: A total of 1,056 VLBWI were included in the study, 552 in the pre-intervention period and 504 in the post-intervention period. The implementation of surveillance cultures and decolonization of colonized patients resulted in a 50% reduction of incidence rates per 1,000 patient-days of MSSA-attributable infections (1.63 [95% CI 1.12-2.31] vs. 0.83 [95% CI 0.47-1.35], p = 0.024). No adverse effects were observed from application of the decolonization protocol with mupirocin and octenidin. No mupirocin-resistant MSSA strains were detected during the study period. Conclusion: Implementation of an active surveillance and decolonization protocol resulted in a reduction of MSSA-attributable infections in VLBWI.

1.
Stoll BJ, Hansen N: Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol 2003;27:293-301.
2.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh W, Bauer CR, Korones SB, Shankaran S, Laptook AR, Stevenson DK, Papile LA, Poole WK: Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-291.
3.
Verstraete E, Boelens J, De Coen K, Claeys G, Vogelaers D, Vanhaesebrouck P, Blot S: Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol 2014;35:511-518.
4.
Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, Higgins RD; NICHD Neonatal Research Network: Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357-2365.
5.
Carey AJ, Long SS: Staphylococcus aureus: a continuously evolving and formidable pathogen in the neonatal intensive care unit. Clin Perinatol 2010;37:535-546.
6.
Shane AL, Hansen NI, Stoll BJ, Bell EF, Sanchez PJ, Shankaran S, Laptook AR, Das A, Walsh MC, Hale EC, Newman NS, Schrag SJ, Higgins RD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network: Methicillin-resistant and susceptible Staphylococcus aureus bacteremia and meningitis in preterm infants. Pediatrics 2012;129:e914-e922.
7.
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;30:135-139.
8.
Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee: Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165-S193.
9.
Ericson JE, Popoola VO, Smith PB, Benjamin DK, Fowler VG, Benjamin DK Jr, Clark RH, Milstone AM: Burden of invasive Staphylococcus aureus infections in hospitalized infants. JAMA Pediatr 2015;169:1105-1111.
10.
Steiner M, Langgartner M, Cardona F, Waldhor T, Schwindt J, Haiden N, Berger A: Significant reduction of catheter-associated bloodstream infections in preterm neonates after implementation of a care bundle focusing on simulation training of central line insertion. Pediatr Infect Dis J 2015;34:1193-1196.
11.
Adlassnig KP, Berger A, Koller W, Blacky A, Mandl H, Unterasinger L, Rappelsberger A: Healthcare-associated infection surveillance and bedside alerts. Stud Health Technol Inform 2014;198:71-78.
12.
Centers for Disease Control and Prevention: National Healthcare Safety Network (NHSN) Patient Safety Component Manual, 2017.
13.
Delaney HM, Wang E, Melish M: Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates. J Perinatol 2013;33:313-318.
14.
Popoola VO, Colantuoni E, Suwantarat N, Pierce R, Carroll KC, Aucott SW, Milstone AM: Active surveillance cultures and decolonization to reduce Staphylococcus aureus infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2016;37:381-387.
15.
Popoola VO, Milstone AM: Decolonization to prevent Staphylococcus aureus transmission and infections in the neonatal intensive care unit. J Perinatol 2014;34:805-810.
16.
Milstone AM, Budd A, Shepard JW, Ross T, Aucott S, Carroll KC, Perl TM: Role of decolonization in a comprehensive strategy to reduce methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit: an observational cohort study. Infect Control Hosp Epidemiol 2010;31:558-560.
17.
Popoola VO, Budd A, Wittig SM, Ross T, Aucott SW, Perl TM, Carroll KC, Milstone AM: 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;35:412-418.
18.
Nelson MU, Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG: One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units. J Perinatol 2014;34:653-655.
19.
Jones JC, Rogers TJ, Brookmeyer P, Dunne WM, Jr., Storch GA, Coopersmith CM, Fraser VJ, Warren DK: Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 2007;45:541-547.
20.
Hetem DJ, Vogely HC, Severs TT, Troelstra A, Kusters JG, Bonten MJ: Acquisition of high-level mupirocin resistance in CoNS following nasal decolonization with mupirocin. J Antimicrob Chemother 2015;70:1182-1184.
21.
Olm MR, Brown CT, Brooks B, Firek B, Baker R, Burstein D, Soenjoyo K, Thomas BC, Morowitz M, Banfield JF: Identical bacterial populations colonize premature infant gut, skin, and oral microbiomes and exhibit different in situ growth rates. Genome Res 2017;27:601-612.
22.
Groer MW, Gregory KE, Louis-Jacques A, Thibeau S, Walker WA: The very low birth weight infant microbiome and childhood health. Birth Defects Res C Embryo Today 2015;105:252-264.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.