title: Active Surveillance Cultures and Decolonization to Reduce Staphylococcus aureus Infections in the Neonatal Intensive Care Unit.
abstract: BACKGROUND
  Staphylococcus aureus is a common cause of healthcare-associated infections in neonates.
  
  
  OBJECTIVE
  To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance.
  
  
  METHODS
  We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models.
  
  
  RESULTS
  Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected.
  
  
  CONCLUSIONS
  Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
authors.affiliation: 1Division of Pediatric Infectious Diseases,Department of Pediatrics,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Victor O
authors.initials: VO
authors.lastname: Popoola
authors.affiliation: 2Department of Biostatistics,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.affiliation: 3Division of Medical Microbiology,Department of Pathology,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Nuntra
authors.initials: N
authors.lastname: Suwantarat
authors.affiliation: 4Department of Epidemiology,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pierce
authors.affiliation: 4Department of Epidemiology,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.affiliation: 5Division of Neonatology,Department of Pediatrics,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Aucott
authors.affiliation: 1Division of Pediatric Infectious Diseases,Department of Pediatrics,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal; D008297:Male; D008396:Maryland; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D016712:Mupirocin / Q000627:therapeutic use*; D012044:Regression Analysis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D063128:Tertiary Health Care
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin