title: Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention.
abstract: OBJECTIVE
  To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control.
  
  
  METHODS
  Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home.
  
  
  METHODS
  Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and an MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for 21 days or more became recolonized with MRSA. Using PFGE, there were 14 different strain types identified, with USA300 being the most common (31%).
  
  
  CONCLUSIONS
  Current strategies to prevent infections-including active identification and decolonization of MRSA-colonized neonates-are inadequate because infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Victor O
authors.initials: VO
authors.lastname: Popoola
authors.forename: Alicia
authors.initials: A
authors.lastname: Budd
authors.forename: Sara M
authors.initials: SM
authors.lastname: Wittig
authors.forename: Tracy
authors.initials: T
authors.lastname: Ross
authors.forename: Susan W
authors.initials: SW
authors.lastname: Aucott
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
mesh_terms: D000046:Academic Medical Centers; D015142:Baltimore; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008485:Medical Audit; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*