Abstract
IntroductionThe purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission.MethodsData were collected retrospectively from medical records and the Danish Neobase database. All MRSA isolates obtained from neonates, relatives and NICU health care workers (HCW) as well as environmental cultures were typed.ResultsDuring the 46 day outbreak period, 102 neonates were admitted to the two neonatal wards. Ninety-nine neonates were subsequently sampled, and 32 neonates (32%) from 25 families were colonized with MRSA (spa-type t127, SCCmec V, PVL negative). Thirteen family members from 11 of those families (44%) and two of 161 HCWs (1%) were colonized with the same MRSA. No one was infected. Five environmental cultures were MRSA positive. In a multiple logistic regression analysis, nasal Continuous Positive Airway Pressure (nCPAP) treatment (p = 0.006) and Caesarean section (p = 0.016) were independent risk factors for MRSA acquisition, whereas days of exposure to MRSA was a risk factors in the unadjusted analysis (p = 0.04).ConclusionsMRSA transmission occurs with high frequency in the NICU during hospitalization with unidentified MRSA neonates. Caesarean section and nCPAP treatment were identified as risk factors for MRSA colonization. The MRSA outbreak was controlled through infection control procedures.
Highlights
The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission
This globally changing epidemiology has, in part, been caused by community-associated MRSA (CA-MRSA) – new MRSA types initially not found in the hospital and characterized by carrying small SCCmec cassette type IV or V and sometimes the Panton-Valentine leukocidin (PVL) gene [2]
Major health-care associated MRSA outbreaks are rare in Denmark with 22 identified outbreaks in 2011– the largest outbreaks occurred at neonatal departments in the Copenhagen area and Zealand, comprising a total of 26 cases [3]
Summary
The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission. Some MRSA clones have had the capacity for pandemic spread, while others gave predominantly local epidemics [1], [2] This globally changing epidemiology has, in part, been caused by community-associated MRSA (CA-MRSA) – new MRSA types initially not found in the hospital and characterized by carrying small SCCmec cassette type IV or V and sometimes the PVL gene [2]. This increase of CA-MRSA has been seen in Denmark, where the annual number of new MRSA cases has increased significantly from 100 in 2002 to 1293 cases in 2011 [3], though the prevalence of MRSA in Staphylococcus aureus bacteraemias still remains low (1.6%–21 of 1293 patients in 2011) [3]. We have recently shown, in other Copenhagen hospitals, that CA-
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