title: Impact of routine methicillin-resistant Staphylococcus aureus (MRSA) surveillance and cohorting on MRSA-related bloodstream infection in neonatal intensive care unit.
abstract: OBJECTIVE
  To study the impact of methicillin-resistant Staphylococcus aureus (MRSA) surveillance on the incidence of MRSA-related bloodstream infection (BSI) in neonatal intensive care unit (NICU) and to evaluate cost-effectiveness of MRSA surveillance.
  
  
  METHODS
  MRSA surveillance policy was introduced in our NICU in April 2008. Pre-MRSA surveillance period (P1, April 2006-March 2008) was compared with the surveillance period (P2, April 2008-April 2010) for MRSA-related BSI (MRSA BSI).
  
  
  RESULTS
  During P1 and P2, 1,576 and 1,512 neonates were enrolled. Of these, 3.8/1,000 and 5.3/1,000 developed MRSA BSI, respectively. During P2, 100% MRSA-related BSI occurred in MRSA-colonized neonates, as compared with zero in noncolonized group (p < 0.0001). Overall, 7 (30%) of the 23 neonates colonized during hospitalization developed MRSA BSI as compared with 1 of the 31 (3%) neonates colonized at admission (p = 0.007). Direct screening cost was $208 per patient. Since 28 neonates had to be screened to detect one colonization, $5,824 estimated per detection, excluding indirect costs.
  
  
  CONCLUSIONS
  MRSA surveillance may protect non-MRSA colonized neonates from becoming colonized. This is of considerable importance because the acquisition of colonization during hospitalization was associated with a 10-fold increase in risk of developing MRSA BSI. Cost-effectiveness of MRSA surveillance remains debatable and further studies are needed to delineate cost-benefit ratio.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Kaushik
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, St. Joseph's Children's Hospital, Paterson, New Jersey.
authors.forename: Helen
authors.initials: H
authors.lastname: Kest
authors.affiliation: Division of Neonatology, Department of Pediatrics, St. Joseph's Children's Hospital, Paterson, New Jersey.
authors.forename: Adel
authors.initials: A
authors.lastname: Zauk
authors.affiliation: School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeBari
authors.affiliation: Department of Pediatrics, St. Joseph's Children's Hospital, Paterson, New Jersey.
authors.forename: Michael
authors.initials: M
authors.lastname: Lamacchia
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015997:Neonatal Screening / Q000191:economics*; D013203:Staphylococcal Infections / Q000453:epidemiology*