title: Methicillin-resistant and susceptible Staphylococcus aureus bacteremia and meningitis in preterm infants.
abstract: BACKGROUND
  Data are limited on the impact of methicillin-resistant Staphylococcus aureus (MRSA) on morbidity and mortality among very low birth weight (VLBW) infants with S aureus (SA) bacteremia and/or meningitis (B/M).
  
  
  METHODS
  Neonatal data for VLBW infants (birth weight 401-1500 g) born January 1, 2006, to December 31, 2008, who received care at centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were collected prospectively. Early-onset (≤72 hours after birth) and late-onset (>72 hours) infections were defined by blood or cerebrospinal fluid cultures and antibiotic treatment of ≥5 days (or death <5 days with intent to treat). Outcomes were compared for infants with MRSA versus methicillin-susceptible S aureus (MSSA) B/M.
  
  
  RESULTS
  Of 8444 infants who survived >3 days, 316 (3.7%) had SA B/M. Eighty-eight had MRSA (1% of all infants, 28% of infants with SA); 228 had MSSA (2.7% of all infants, 72% of infants with SA). No infant had both MRSA and MSSA B/M. Ninety-nine percent of MRSA infections were late-onset. The percent of infants with MRSA varied by center (P < .001) with 9 of 20 centers reporting no cases. Need for mechanical ventilation, diagnosis of respiratory distress syndrome, necrotizing enterocolitis, and other morbidities did not differ between infants with MRSA and MSSA. Mortality was high with both MRSA (23 of 88, 26%) and MSSA (55 of 228, 24%).
  
  
  CONCLUSIONS
  Few VLBW infants had SA B/M. The 1% with MRSA had morbidity and mortality rates similar to infants with MSSA. Practices should provide equal focus on prevention and management of both MRSA and MSSA infections among VLBW infants.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA. ashane@emory.edu
authors.forename: Andi L
authors.initials: AL
authors.lastname: Shane
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Schrag
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008712:Methicillin / Q000627:therapeutic use*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D008712:Methicillin