Surveillance for colonization, transmission, and infection with methicillin-susceptible staphylococcus aureus in a neonatal intensive care unit
Staphylococcus aureus is one of the leading causes of infections in neonatal intensive care units (NICUs). Most studies in this patient group focus on methicillin-resistant S aureus or the outbreak setting, whereas data for methicillin-susceptible S aureus are limited.To identify risk factors for S...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2021
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| In: |
JAMA network open
Year: 2021, Volume: 4, Issue: 9, Pages: 1-13 |
| ISSN: | 2574-3805 |
| DOI: | 10.1001/jamanetworkopen.2021.24938 |
| Online Access: | Verlag, kostenfrei, Volltext: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783982 Verlag, kostenfrei, Volltext: https://doi.org/10.1001/jamanetworkopen.2021.24938 
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| Author Notes: | Dennis Nurjadi, Vanessa M. Eichel, Patrik Tabatabai, Sabrina Klein, Katharina Last, Nico T. Mutters, Johannes Pöschl, Philipp Zanger, Klaus Heeg, Sébastien Boutin |
| Summary: | Staphylococcus aureus is one of the leading causes of infections in neonatal intensive care units (NICUs). Most studies in this patient group focus on methicillin-resistant S aureus or the outbreak setting, whereas data for methicillin-susceptible S aureus are limited.To identify risk factors for S aureus colonization and infections in hospitalized newborns and to investigate S aureus transmission and its dynamics in a nonoutbreak setting.This monocentric cohort study in a tertiary NICU in Heidelberg, Germany, enrolled all hospitalized neonates (n = 590) with at least 1 nasal screening swab positive for S aureus. Data were collected from January 1, 2018, to December 31, 2019.Weekly screening for S aureus colonization was performed for all newborns until discharge.The primary end point was any S aureus infection until hospital discharge. Transmission of S aureus and performance of routine typing to detect transmissions were defined as the secondary outcomes of the study.In total, 590 newborns were enrolled (276 [46.8%] female and 314 [53.2%] male; 220 [37.3%] with birthweight <1500 g; 477 [80.8%] preterm; 449 [76.1%] singletons; 419 [71.5%] delivered via cesarean section). The median length of stay was 26 (range, 10-62) days. Overall, 135 infants (22.9%) were colonized by S aureus at some time during their hospital stay. The median time to first detection was 17 (interquartile range, 11-37) days. The overall incidence of S aureus infection was 1.7% (10 of 590). Low birth weight (<1500 g [odds ratio, 9.3; 95% CI, 5.9-14.6; P < .001]) and longer hospital stay (odds ratio, 2.3; 95% CI, 1.9-2.7; P < .001) were associated with colonization. Nasal carriage was significantly associated with S aureus infection (odds ratio, 8.2; 95% CI, 2.1-32.3; P = .002). A total of 123 of 135 colonization isolates were sequenced. All recoverable infection isolates (4 of 7) of newborns with colonization were genetically identical to the colonizing isolate. Whole-genome sequencing indicated 23 potential transmission clusters.The findings of this cohort study suggest that nasal colonization is a relevant risk factor for S aureus infection in a nonoutbreak NICU setting. In colonized newborns, infection and colonization isolates were genetically identical, suggesting that eradication of colonization may be a useful measure to prevent infection. Further investigations are necessary to validate and assess the generalizability of our findings. |
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| Item Description: | Gesehen am 14.10.2021 |
| Physical Description: | Online Resource |
| ISSN: | 2574-3805 |
| DOI: | 10.1001/jamanetworkopen.2021.24938 |