title: Comparison of community-acquired methicillin-resistant Staphylococcus aureus bacteremia to other staphylococcal species in a neonatal intensive care unit.
abstract: Hospital acquired infections including staphylococcal species are common in neonatal intensive care units. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was recently observed in our unit. The clinical and laboratory characteristics of all neonates with Staphylococcus aureus bacteremia during an 11-year period were retrospectively reviewed. Three groups of patients were compared: 1. Patients with CA-MRSA defined as MRSA-resistant only to beta-lactams, but sensitive to all other antibiotic groups and carried SCCmec IV. 2. Patients with multi-drug-resistant (MDR)-MRSA and 3. Patients with MSSA (methicillin-sensitive S. aureus). Forty-three neonates with documented S. aureus bacteremia were included. Of these 41 were preterm babies. Eleven infants had CA-MRSA, 20 had MDR-MRSA and 12 had MSSA bacteremia, the Panton-Valentine-Leukocidine gene (pvl-gene) was not present in any of these strains. Risk factors, clinical manifestations and laboratory tests were similar in all three groups studied. Although neonates infected with CA-MRSA were more premature and had more related diseases, the mortality rate was similar in all groups (9.1% in the CA-MRSA group). Skin infections, osteomyelitis or pneumatocele were not observed more frequently in the CA-MRSA group. We did not find significant differences in risk factors or outcomes in neonates in the three groups. One possible explanation for this observation is that the CA-MRSA outbreak strain did not contain the pvl-gene, which has been suggested to be a significant virulence factor.
authors.affiliation: Neonatal Department, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. kuint-j@sheba.health.gov.il
authors.forename: Jacob
authors.initials: J
authors.lastname: Kuint
authors.forename: Asher
authors.initials: A
authors.lastname: Barzilai
authors.forename: Gili
authors.initials: G
authors.lastname: Regev-Yochay
authors.forename: Ethan
authors.initials: E
authors.lastname: Rubinstein
authors.forename: Nati
authors.initials: N
authors.lastname: Keller
authors.forename: Ayala
authors.initials: A
authors.lastname: Maayan-Metzger
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents