Clinical outcomes in methicillin-resistant Staphylococcus aureus-colonized neonates in the neonatal intensive care unit.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) colonization can persist for prolonged periods, and patient-related factors are associated with persistent carriage in adults. However, such knowledge is lacking among neonates.


OBJECTIVE
To better understand the outcome of MRSA-colonized neonates in the neonatal intensive care unit (NICU), we prospectively followed all colonized neonates until decolonization over 39 months and determined the incidence, duration of colonization, clinical outcomes and risk factors associated with prolonged carriage of MRSA.


METHODS
Nasal and inguinal cultures were obtained from all newly admitted neonates following an outbreak of MRSA. Weekly and 1-2 monthly cultures were obtained from all hospitalized and discharged neonates colonized with MRSA, respectively, until 2 consecutive cultures were negative.


RESULTS
152 of 1,456 (10.4%) neonates became colonized. The mean time to acquire MRSA colonization was 17.1 +/- 40.7 (range 1-471) days. The median time to decolonization was 36 days. About 20% of decolonized patients had been colonized for a prolonged period of >or=160 days. 47.5% of colonized patients were sent home colonized, and none with prolonged carriage developed MRSA-related infections in the following 6 months in contrast to 6 infants (3.9%) who developed MRSA sepsis during hospitalization. The only risk factor associated with prolonged carriage was the concurrent colonization of both the inguinal and nasal areas on admission.


CONCLUSIONS
Nearly all neonates with acquired colonization became decolonized either prior to or after discharge from NICU. A significant percentage failed to decolonize prior to hospital discharge, but almost all decolonized by 30 months in the community without evidence of systemic or local infections.
Kim
Young Hee
YH
Division of Neonatology, Department of Pediatrics, Clinical Research Center, University of Ulsan College of Medicine, Seoul, Korea.
Chang
Sung Soo
SS
Kim
Yang Soo
YS
Kim
Ellen Ai-Rhan
EA
Yun
Sung Cheol
SC
Kim
Ki Soo
KS
Pi
Soo Young
SY
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D016106:Methicillin Resistance; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000401:mortality; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents