title: Staphylococcus aureus in a neonatal care center: methicillin-susceptible strains should be a main concern.
abstract: BACKGROUND
  In the context of a methicillin-susceptible Staphylococcus aureus (MSSA) outbreak, we aimed to improve our knowledge of S. aureus (SA) epidemiology in the neonatal care center (NCC) of a tertiary care teaching hospital.
  
  
  METHODS
  We performed a complete one-year review of SA carrier, colonized or infected patients. Monthly prevalence and incidence of SA intestinal carriage, colonization and infection were calculated and the types of infection analysed. During the MSSA outbreak, strains were studied for antimicrobial resistance, content of virulence genes and comparative fingerprint in Pulsed-Field Gel Electrophoresis. Hand hygiene and catheter-related practices were assessed by direct observational audits. Environmental investigation was performed in search of a SA reservoir.
  
  
  RESULTS
  Epidemiological analyses showed 2 or 3 prevalence peaks on a background of SA endemicity. In the NCC, during 2009, overall MSSA prevalence did not decrease below 5.5%, while mean MRSA prevalence was about 1.53%. Analysis of infection cases revealed that the outbreak corresponded to the emergence of catheter-related infections and was probably related to the relaxation in infection control practices in a context of high colonization pressure. Health care workers' white coats appeared as a potential environmental reservoir that could perpetuate SA circulation in the ward.
  
  
  CONCLUSIONS
  This report emphasizes the importance of integrating MSSA along with methicillin-resistant SA in a program of epidemiological surveillance in the NCC.
authors.affiliation: Université Montpellier 1, UMR 5119, Equipe Pathogènes et Environnements, U.F.R. des Sciences Pharmaceutiques et Biologiques, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France ; Centre Hospitalier Régional Universitaire de Montpellier, Hôpital La Colombière, Service d'Hygiène Hospitalière, 39 avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
authors.forename: Sara
authors.initials: S
authors.lastname: Romano-Bertrand
authors.affiliation: Université Montpellier 1, UMR 5119, Equipe Pathogènes et Environnements, U.F.R. des Sciences Pharmaceutiques et Biologiques, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France ; Centre Hospitalier Régional Universitaire de Nîmes, Service de Pédiatrie, Hôpital Caremeau, Place du Pr R. Debré, 30029 Nîmes Cedex 9, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Filleron
authors.affiliation: Centre Hospitalier Régional Universitaire de Montpellier, Service de Néonatologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mesnage
authors.affiliation: Centre Hospitalier Régional Universitaire de Montpellier, Hôpital La Colombière, Service d'Hygiène Hospitalière, 39 avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lotthé
authors.affiliation: Centre Hospitalier Régional Universitaire de Montpellier, Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
authors.forename: Marie Noëlle
authors.initials: MN
authors.lastname: Didelot
authors.affiliation: Centre Hospitalier Régional Universitaire de Montpellier, Hôpital La Colombière, Service d'Hygiène Hospitalière, 39 avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
authors.forename: Lydie
authors.initials: L
authors.lastname: Burgel
authors.affiliation: Université Montpellier 1, UMR 5119, Equipe Pathogènes et Environnements, U.F.R. des Sciences Pharmaceutiques et Biologiques, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France ; Centre Hospitalier Régional Universitaire de Montpellier, Hôpital La Colombière, Service d'Hygiène Hospitalière, 39 avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Jumas Bilak
authors.affiliation: Centre Hospitalier Régional Universitaire de Montpellier, Service de Néonatologie, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.affiliation: Centre Hospitalier Régional Universitaire de Montpellier, Hôpital La Colombière, Service d'Hygiène Hospitalière, 39 avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Parer
keywords: Catheter-related infections; Methicillin-susceptible Staphylococcus aureus; Prevalence; Staphylococcus aureus; White coat contamination
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