Decolonization to Prevent Staphylococcus aureus Transmission and Infections in the Neonatal Intensive Care Unit

VO Popoola; AM Milstone

Disclosures

J Perinatol. 2014;34(11):805-810. 

In This Article

Abstract and Introduction

Abstract

Staphylococcus aureus (S. aureus) continues to be a leading cause of outbreaks and health-care-associated infections in neonatal intensive care units. In the first few months of life, many neonates acquire S. aureus as part of their delicate and evolving microbiota. Neonates that asymptomatically acquire S. aureus colonization are at increased risk of developing a subsequent S. aureus infection. This review discusses the epidemiology and prevention of S. aureus disease in neonates and how decolonization to eradicate S. aureus may decrease S. aureus transmission and infections in the neonatal intensive care unit.

Introduction

Nursery outbreaks of Staphylococcus aureus(S. aureus) have been reported since the 1800s.[1] Over a century later, S. aureus continues to be a leading cause of outbreaks and health-care-associated infections (HAIs) in neonatal intensive care units (NICUs).[2,3]S. aureus is the second most common cause of late-onset sepsis, central line-associated bloodstream infections and ventilator-associated pneumonia in NICUs.[2,4] In a recent review of very low birth weight infants in 20 United States' NICUs, 3.7% of infants had S. aureus bacteremia or meningitis, of which 18.4% died from the infection.[5] Assuming similar outcomes in other NICUs, of the approximately 57 000 very low birth weight infants born in the United States in 2011, there would have been an estimated 400 deaths because of S. aureus bacteremia or meningitis. These estimates only include very low birth weight infants with central nervous system and bloodstream infections; thus, the absolute morbidity and mortality of S. aureus in all hospitalized neonates is likely much greater. Additionally and equally important, even with appropriate therapy, neonatal S. aureus infections can have long-term sequelae including poor neurodevelopmental and growth outcomes.[6,7] Preterm infants with infections are 30% more likely to have a lower mental developmental index, an important predictor of intelligence quotient.[7,8]

In addition to the high burden of S. aureus disease, antibiotic-resistant S. aureus strains, especially methicillin-resistant S. aureus (MRSA), are prevalent and even endemic in some NICUs.[9,10] The incidence of late-onset MRSA infections in US NICUs increased over 300% from 1995 to 2004.[11] MRSA infections have an estimated attributable cost of US$164 301 in neonates.[12] Although often overlooked, methicillin-susceptible S. aureus (MSSA) infections outnumber MRSA infections from three to one, and may have equivalent morbidity and mortality in preterm infants.[5,13,14] Given the burden of S. aureus disease and the associated outcomes in neonates, prevention of S. aureus infections must be a high priority in all NICUs.

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