Staphylococcus aureus colonisation/infection in a neonatal intensive care unit: a four-year study
Abstract number: P1878
Papadimitriou M., Koemtzidou E., Antonaki G., Matsas M., Alexaki A., Kourakis G., Lebessi E.
Objectives: To assess the colonisation/infection by Staphylococcus aureus among neonates in a 30-bed, university-affiliated, level III-IV Neonatal Intensive Care Unit (NICU) at a large paediatric hospital in Athens.
Methods: All cases of S. aureus infection or colonisation in the NICU were identified by using the data from laboratory and the medical records. Routine surveillance cultures for the detection of multidrug resistant pathogens was a standard practice in our NICU. Surveillance consisted of swabbing the throat and rectum upon admission and weekly until discharge. When infection is suspected, additional cultures are taken (blood, urine, stool, skin lesions, umbilical and eye swabs). Culture of samples and identification was made by standard methods. Susceptibility to penicillin (PN), oxacillin (OX), cefoxitin (FOX), kanamycin (KN), tobramycin (TB), gentamicin (GN), erythromycin (ER), clindamycin (CL), ciprofloxacin (CP), fusidic acid (FA), trimethoprim-sulfamethoxazole (SXT), tetracycline (TE), rifampin (RF), chloramphenicol (CHL), vancomycin (VAN) and teicoplanin (TEC) was tested using the disk diffusion method, according to the current CLSI guidelines.
Results: During the study period (20042007), 1822 neonates (59% male and 41% female) were admitted in the NICU. Two hundred seventy neonates (14.8%), ranging in age from 3 to 54days, were found colonised with S. aureus upon admission (referred cases), whereas 69 neonates (3.8%) were colonised during their NICU stay (NICU-acquired cases). The median length of stay to the NICU before colonisation was 14days (range 3207d). The incidence of methicillin resistant S. aureus (MRSA) was 21.8% (59/270) and 23.1% (16/69) among referred and NICU-acquired cases, respectively. Yearly incidence of MRSA isolates from 2004 through 2007 was as follows: 17.1%, 21.2%, 28.0%, and 22.2%. The following resistance phenotypes were identified: PN/OX (33.8%); PN/OX/FA/KN/TE (14.9%); PN/OX/TB/KN (9.5%). Infection due to MSSA was identified in 29 cases (bacteraemia, 3; UTI, 2; opthalmia, 18; cutaneous infections, 3; umbilicitis, 3), and to MRSA in 17 cases (ophthalmia, 8; cutaneous infections, 7; umbilicitis, 2). Epidemics were not identified.
Conclusions:S. aureus appears endemic in maternity units and NICUs. The rate of MRSA is very high. Systematic surveillance to optimise detection of colonised newborns and aggressive infection-control measures in maternity units and NICUs are necessary to prevent the spread of MRSA.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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