Abstract
Staphylococcal colonization is a risk factor for healthcare-associated infections, which are frequent in Neonatal Intensive Care Units (NICU). This study analyzed microbiology, epidemiology and clinical aspects of Staphylococcus spp. colonizing neonates. Nasal or periumbilical swabs were evaluated from 175 newborns admitted to a NICU of a Rio de Janeiro hospital from March to September 2009. Clinical data were obtained from the medical records. SCCmec typing and the mecA and Panton-Valentine Leukocidin (PVL) genes were detected by PCR. Clonal diversity was evaluated by pulsed-field gel electrophoresis. Staphylococcus spp. isolates were detected in 98 (56%) neonates, 66.3% of them had birth weight ≤ 2500 g, 62.2% were preterm (˂ 37 weeks) and the mean length of hospitalization was 14.9 days. Among the 133 isolates identified, 48.1% were S. epidermidis, 23.3% S. haemolyticus and 13.5% S. aureus. Methicillin-resistant Staphylococcus isolate was detected in 77.6% of neonates. The methicillin-resistant S. aureus isolates carried the SCCmec type IV, while 94.6% of S. epidermidis and 85.7% of S. haemolyticus presented non-typeable cassettes. Among the S. aureus, 55.6% had PVL genes and the USA800 genotype was prevalent. Two genotypes of S. epidermidis and one of S. haemolyticus clustered 42.2% and 25.8% of the isolates, respectively. S haemolyticus colonization was associated with the use of parenteral nutrition and mechanical ventilation. High rate of neonates colonized by methicillin-resistant Staphylococcus species and the permanence of clones circulating in the NICU highlight the importance for continuous and preventive surveillance in this high-risk population.
Highlights
Staphylococcal colonization is a risk factor for healthcare-associated infections, which are frequent in Neonatal Intensive Care Units (NICU)
Another disturbing factor is the presence of the Panton-Valentine leukocidin (PVL), a pore-forming toxin associated to a wide range of infections [8] that could exacerbate the prognosis of infected neonates
Coagulase Negative Staphylococcus (CoNS) isolates are normally skin and mucosal surface colonizers. Their access to deep tissues, usually through indwelling devices, can promote an opportunistic infection [1]. They are responsible for 10% to 40% of the bloodstream infections (BSI) [13,6], and a high mortality rate of 46% was already associated to infections by CoNS in an intensive care unit [3]
Summary
Neonates admitted to neonatal intensive care units (NICU) are susceptible to health care associated infections (HCAI) due to low birth weight, poor skin integrity, immature immune system and frequent use of invasive devices [1]. Staphylococcus aureus is the etiologic agent of 10% to 25% of HCAI in NICUs [14], while methicillin-resistant S. aureus (MRSA) isolates are responsible of 2 to 5% of these infections [5,6] and are associated with significant morbidity and financial burden [7] Another disturbing factor is the presence of the Panton-Valentine leukocidin (PVL), a pore-forming toxin associated to a wide range of infections [8] that could exacerbate the prognosis of infected neonates. Coagulase Negative Staphylococcus (CoNS) isolates are normally skin and mucosal surface colonizers Their access to deep tissues, usually through indwelling devices, can promote an opportunistic infection [1]. We characterized Staphylococcus spp. isolates colonizing patients in a Neonatal Intensive Care Unit in Rio de Janeiro in order to verify which species of this genus are circulating in the unit, their antimicrobial susceptibility profile, clonal diversity and associated clinical aspects
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