title: Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Critically Ill Children in a State With Mandated Active Surveillance.
abstract: BACKGROUND
  In theory, active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) reduces MRSA spread by identifying all MRSA-colonized patients and placing them under contact precautions. In October 2007, Illinois mandated active MRSA surveillance in all intensive care units, including neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). We evaluated MRSA trends in a large metropolitan region in the wake of this law.
  
  
  METHODS
  Chicago hospitals with a NICU or PICU were recruited for 8 single-day point prevalence surveys that occurred twice-yearly between June 2008 and July 2011 and then yearly in 2012 to 2013. Samples from all patients were cultured for MRSA (nose and umbilicus for neonates, nose and groin for pediatric patients). Hospital-reported admission MRSA-screening results also were obtained. Point prevalence cultures were screened for MRSA by using broth enrichment, chromogenic agar, and standard confirmatory methods.
  
  
  RESULTS
  All eligible hospitals (N = 10) participated (10 NICUs, 6 PICUs). Hospital-reported adherence to state-mandated MRSA screening at admission was high (95% for NICUs, 94% for PICUs). From serial point prevalence surveys, overall MRSA prevalences in the NICUs and PICUs were 4.2% (89 of 2101) and 5.7% (36 of 632), respectively. MRSA colonization prevalences were unchanged in the NICUs (year-over-year risk ratio [RR], 0.93 [95% confidence interval (CI), 0.78-1.12]; P = .45) and trended toward an increase in the PICUs (RR, 1.25 [95% CI, 0.72-2.12]; P = .053). We estimated that 81% and 40% of MRSA-positive patients in the NICUs and PICUs, respectively, had newly acquired MRSA.
  
  
  CONCLUSIONS
  In a region with mandated active MRSA surveillance, we found ongoing unchanged rates of MRSA colonization and acquisition among NICU and PICU patients.
authors.affiliation: Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois.
authors.forename: Rosie D
authors.initials: RD
authors.lastname: Lyles
authors.affiliation: Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois.|Department of Medicine.
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
authors.affiliation: Department of Medicine.|Department of Pathology.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
authors.affiliation: Department of Pathology.
authors.forename: Karen
authors.initials: K
authors.lastname: Lolans
authors.affiliation: Department of Nursing.
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.affiliation: Department of Pediatrics, Rush University Medical Center, Chicago, Illinois.
authors.forename: Latania K
authors.initials: LK
authors.lastname: Logan
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.
authors.forename: Stanford T
authors.initials: ST
authors.lastname: Shulman
authors.affiliation: Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois.|Department of Medicine.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.affiliation: Department of Medicine.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Lin
mesh_terms: D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015278:Intensive Care Units, Pediatric; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D011159:Population Surveillance; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology*
keywords: active surveillance; colonization; epidemiology; intensive care unit; methicillin-resistant Staphylococcus aureus