title: Non-multidrug-resistant, methicillin-resistant Staphylococcus aureus in a neonatal unit.
abstract: BACKGROUND
  In the last decade, non-multiresistant methicillin-resistant Staphylococcus aureus (NM-MRSA) has been described as an important agent in bloodstream infections in our hospital.
  
  
  METHODS
  This prospective cohort study, conducted from February 2009 through January 2010 in the neonatal unit, evaluated 403 newborns (NB), their 382 mothers and 148 health care workers (HCW).
  
  
  RESULTS
  Approximately 217 NB (54%), 187 mothers (48%) and 87 HCW (59%) were colonized by S. aureus (SA). MRSA colonization was greater among NB (15%) than mothers (4.7%) and HCW (3.4%). Although mother-to-NB transmission occurred, in most cases mothers were not responsible for NB colonization. There were 2 predominant PFGE patterns among the NB and some mothers and HCW became colonized by them. Factors significantly associated with MRSA carriage by NB were lower level of maternal schooling (risk factor: odds ratio: 2.99; 95% confidence interval: 1.10-8.07) and maternal rhinosinusitis (protective factor: odds ratio: 0.33; 95% confidence interval:0.12-0.88). Among NB who remained hospitalized for more than 72 hours, breast feeding was protective (odds ratio: 0.22; 95% confidence interval: 0.05-0.98). All the isolates were NM-MRSA, carried few virulence factors and SCCmec types IVa and type IVd predominated.
  
  
  CONCLUSIONS
  Although there were no cases of infection, nosocomial transmission of MRSA clearly occurred in the neonatal unit, and this highlights the need for infection control practices such as hand hygiene to prevent cross-dissemination. Other healthcare practices, which are very basic but also ample in scope, may play a role, such as general education of women and breast feeding.
authors.affiliation: From the *Department of Infectious Diseases and LIM-54; †Department of Infection Control, Hospital das Clínicas; ‡Department of Pediatrics; §Faculty of Public Health; ¶Department of Obstetrics; and ‖Instituto de Medicina Tropical de São Paulo, University of São Paulo, São Paulo, Brazil.
authors.forename: Cilmara P
authors.initials: CP
authors.lastname: Garcia
authors.forename: Juliana F
authors.initials: JF
authors.lastname: Rosa
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cursino
authors.forename: Renata D
authors.initials: RD
authors.lastname: Lobo
authors.forename: Carla H
authors.initials: CH
authors.lastname: Mollaco
authors.forename: Satiko
authors.initials: S
authors.lastname: Gobara
authors.forename: Paula B
authors.initials: PB
authors.lastname: Malieno
authors.forename: Gabriela F
authors.initials: GF
authors.lastname: Raymundo
authors.forename: Robson E
authors.initials: RE
authors.lastname: Soares
authors.forename: Kleiste G
authors.initials: KG
authors.lastname: Keil
authors.forename: Edi
authors.initials: E
authors.lastname: Toma
authors.forename: Matias C
authors.initials: MC
authors.lastname: Salomão
authors.forename: M Helena
authors.initials: MH
authors.lastname: Matté
authors.forename: Vera L
authors.initials: VL
authors.lastname: Krebs
authors.forename: M Augusta
authors.initials: MA
authors.lastname: Gibelli
authors.forename: Mario M
authors.initials: MM
authors.lastname: Kondo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
authors.forename: Silvia F
authors.initials: SF
authors.lastname: Costa
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State / Q000382:microbiology*; D015331:Cohort Studies; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D017720:Molecular Epidemiology; D058889:Molecular Typing; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000635:transmission
chemical_list: D000900:Anti-Bacterial Agents