Active surveillance cultures and decolonization to reduce staphylococcus aureus infections in the neonatal intensive care unit

Victor O. Popoola, Elizabeth Colantuoni, Nuntra Suwantarat, Rebecca Pierce, Karen C. Carroll, Susan W. Aucott, Aaron M. Milstone

Research output: Contribution to journalArticlepeer-review

Abstract

background. Staphylococcus aureus is a common cause of healthcare-associated infections in neonates. objective. To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. methods. We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014.We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models. results. Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected. conclusion. Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.

Original languageEnglish (US)
Pages (from-to)381-387
Number of pages7
JournalInfection control and hospital epidemiology
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2016

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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