Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU

Ibukunoluwa C. Akinboyo, Annie Voskertchian, Gezahegn Gorfu, Joshua Francis Betz, Tracy L. Ross, Karen C Carroll, Aaron Milstone

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Abstract

ObjectivesTo examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.Study designSingle-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.SettingJohns Hopkins Hospital's 45-bed level IV NICU in Baltimore, Maryland.MethodsDemographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.ResultsOf 2,060 infants screened for S. aureus, 271 (13%) were colonized, and 203 of these 271 (75%) received intranasal mupirocin. Of those treated, 162 (80%) had follow-up surveillance cultures, and 63 of these 162 infants (39%) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.19-5.90; and HR, 2.21; 95% CI, 1.02-4.75, respectively).ConclusionStrains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.

Original languageEnglish (US)
JournalInfection Control and Hospital Epidemiology
DOIs
StateAccepted/In press - Jan 1 2018

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Neonatal Intensive Care Units
Staphylococcus aureus
Epidemiology
Newborn Infant
Mupirocin
Nose
Confidence Intervals
Baltimore
Pulsed Field Gel Electrophoresis
Masks
Cohort Studies
Retrospective Studies
Equipment and Supplies
Therapeutics

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU",
abstract = "ObjectivesTo examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.Study designSingle-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.SettingJohns Hopkins Hospital's 45-bed level IV NICU in Baltimore, Maryland.MethodsDemographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.ResultsOf 2,060 infants screened for S. aureus, 271 (13{\%}) were colonized, and 203 of these 271 (75{\%}) received intranasal mupirocin. Of those treated, 162 (80{\%}) had follow-up surveillance cultures, and 63 of these 162 infants (39{\%}) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95{\%} confidence interval [CI], 1.19-5.90; and HR, 2.21; 95{\%} CI, 1.02-4.75, respectively).ConclusionStrains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.",
author = "Akinboyo, {Ibukunoluwa C.} and Annie Voskertchian and Gezahegn Gorfu and Betz, {Joshua Francis} and Ross, {Tracy L.} and Carroll, {Karen C} and Aaron Milstone",
year = "2018",
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doi = "10.1017/ice.2018.223",
language = "English (US)",
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T1 - Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU

AU - Akinboyo, Ibukunoluwa C.

AU - Voskertchian, Annie

AU - Gorfu, Gezahegn

AU - Betz, Joshua Francis

AU - Ross, Tracy L.

AU - Carroll, Karen C

AU - Milstone, Aaron

PY - 2018/1/1

Y1 - 2018/1/1

N2 - ObjectivesTo examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.Study designSingle-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.SettingJohns Hopkins Hospital's 45-bed level IV NICU in Baltimore, Maryland.MethodsDemographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.ResultsOf 2,060 infants screened for S. aureus, 271 (13%) were colonized, and 203 of these 271 (75%) received intranasal mupirocin. Of those treated, 162 (80%) had follow-up surveillance cultures, and 63 of these 162 infants (39%) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.19-5.90; and HR, 2.21; 95% CI, 1.02-4.75, respectively).ConclusionStrains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.

AB - ObjectivesTo examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.Study designSingle-center retrospective cohort study of neonates admitted to the neonatal intensive care unit (NICU) from April 2013 to December 2015, during which weekly nasal cultures from hospitalized NICU patients were routinely obtained for S. aureus surveillance.SettingJohns Hopkins Hospital's 45-bed level IV NICU in Baltimore, Maryland.MethodsDemographics and clinical data were collected on all neonates admitted to the NICU with S. aureus nasal colonization who underwent mupirocin-based decolonization during the study period. A decolonized neonate was defined as a neonate with ≥1 negative culture after intranasal mupirocin treatment. Pulsed-field gel electrophoresis was used for strain typing.ResultsOf 2,060 infants screened for S. aureus, 271 (13%) were colonized, and 203 of these 271 (75%) received intranasal mupirocin. Of those treated, 162 (80%) had follow-up surveillance cultures, and 63 of these 162 infants (39%) developed recurrent colonization after treatment. The S. aureus strains were often genetically similar before and after decolonization. The presence of an endotracheal tube or nasal cannula/mask was associated with an increased risk of recurrent S. aureus colonization (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.19-5.90; and HR, 2.21; 95% CI, 1.02-4.75, respectively).ConclusionStrains identified before and after decolonization were often genetically similar, and the presence of invasive respiratory devices increased the risk of recurrent S. aureus nasal colonization in neonates. To improve decolonization efficacy, alternative strategies may be needed.

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