Abstract
BackgroundIn the context of a methicillin-susceptible Staphylococcus aureus (MSSA) outbreak, we aimed to improve our knowledge of S. aureus (SA) epidemiology in the neonatal care center (NCC) of a tertiary care teaching hospital.MethodsWe performed a complete one-year review of SA carrier, colonized or infected patients. Monthly prevalence and incidence of SA intestinal carriage, colonization and infection were calculated and the types of infection analysed. During the MSSA outbreak, strains were studied for antimicrobial resistance, content of virulence genes and comparative fingerprint in Pulsed-Field Gel Electrophoresis. Hand hygiene and catheter-related practices were assessed by direct observational audits. Environmental investigation was performed in search of a SA reservoir.ResultsEpidemiological analyses showed 2 or 3 prevalence peaks on a background of SA endemicity. In the NCC, during 2009, overall MSSA prevalence did not decrease below 5.5%, while mean MRSA prevalence was about 1.53%. Analysis of infection cases revealed that the outbreak corresponded to the emergence of catheter-related infections and was probably related to the relaxation in infection control practices in a context of high colonization pressure. Health care workers’ white coats appeared as a potential environmental reservoir that could perpetuate SA circulation in the ward.ConclusionThis report emphasizes the importance of integrating MSSA along with methicillin-resistant SA in a program of epidemiological surveillance in the NCC.
Highlights
In the context of a methicillin-susceptible Staphylococcus aureus (MSSA) outbreak, we aimed to improve our knowledge of S. aureus (SA) epidemiology in the neonatal care center (NCC) of a tertiary care teaching hospital
SA epidemiology in the NCC One hundred and thirty nine patients admitted to the NCC were included in the epidemiological study
Most of them occurred in the Pediatric reanimation and intensive care unit (PRICU) (70.9% of all positive samples), followed by the Neonatal intensive care unit (NICU) (23.3%) and the kangaroo ward (5.8%)
Summary
In the context of a methicillin-susceptible Staphylococcus aureus (MSSA) outbreak, we aimed to improve our knowledge of S. aureus (SA) epidemiology in the neonatal care center (NCC) of a tertiary care teaching hospital. The high incidence of hospital-acquired infections (HAIs) in neonatal intensive care units (NICUs) is related to the immaturity of patients who are subjected to many invasive procedures. As in other hospital units, methicillin-resistant S. aureus (MRSA) outbreaks have often been reported in NICUs [5,6,7,8] whereas, at first glance, methicillin-susceptible S. aureus (MSSA) outbreaks seem less frequent. Patients’ screening and outbreak alert systems in most hospitals focus on MRSA, while MSSA infections are generally treated piecemeal with little or no insight into molecular typing and epidemiology. A study of 358 S. aureus strains (2,007,681 days of hospitalization in 32 healthcare institutions) showed there is a significant increase of bloodstream HAIs largely due to MSSA strains [9,10]
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