R Pierce1, J Lessler1, V O Popoola2, A M Milstone3. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA. 3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MA, USA. Electronic address: amilsto1@jhmi.edu.
Abstract
BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that drive MRSA transmission. AIM: To measure the association between colonization pressure from decolonized and non-decolonized neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA. METHODS: An eight-year retrospective cohort study was conducted in a level-4 NICU that used active surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (non-decolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of incident MRSA colonization associated with colonization pressure exposures. The population-attributable fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or untreated patients in this setting. FINDINGS: Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6% increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01-1.11]. Risk of acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98-1.04). In the context of this MRSA control programme, 22% (95% CI: 4.0-37) of MRSA acquisition could be attributed to exposures to untreated MRSA carriers. CONCLUSION: Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and require further investigation.
BACKGROUND:Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that drive MRSA transmission. AIM: To measure the association between colonization pressure from decolonized and non-decolonized neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA. METHODS: An eight-year retrospective cohort study was conducted in a level-4 NICU that used active surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (non-decolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of incident MRSA colonization associated with colonization pressure exposures. The population-attributable fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or untreated patients in this setting. FINDINGS: Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6% increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01-1.11]. Risk of acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98-1.04). In the context of this MRSA control programme, 22% (95% CI: 4.0-37) of MRSA acquisition could be attributed to exposures to untreated MRSA carriers. CONCLUSION: Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and require further investigation.
Authors: Aaron M Milstone; Alicia Budd; John W Shepard; Tracy Ross; Susan Aucott; Karen C Carroll; Trish M Perl Journal: Infect Control Hosp Epidemiol Date: 2010-05 Impact factor: 3.254
Authors: Maria G Dominguez-Bello; Elizabeth K Costello; Monica Contreras; Magda Magris; Glida Hidalgo; Noah Fierer; Rob Knight Journal: Proc Natl Acad Sci U S A Date: 2010-06-21 Impact factor: 11.205
Authors: Aaron M Milstone; Brian W Goldner; Tracy Ross; John W Shepard; Karen C Carroll; Trish M Perl Journal: Clin Infect Dis Date: 2011-08-29 Impact factor: 9.079
Authors: J Merrer; F Santoli; C Appéré de Vecchi; B Tran; B De Jonghe; H Outin Journal: Infect Control Hosp Epidemiol Date: 2000-11 Impact factor: 3.254
Authors: James R Price; Tanya Golubchik; Kevin Cole; Daniel J Wilson; Derrick W Crook; Guy E Thwaites; Rory Bowden; A Sarah Walker; Timothy E A Peto; John Paul; Martin J Llewelyn Journal: Clin Infect Dis Date: 2013-12-12 Impact factor: 9.079
Authors: Colin J Worby; Dakshika Jeyaratnam; Julie V Robotham; Theodore Kypraios; Philip D O'Neill; Daniela De Angelis; Gary French; Ben S Cooper Journal: Am J Epidemiol Date: 2013-04-16 Impact factor: 4.897
Authors: Karen L Kotloff; Debbie-Ann T Shirley; C Buddy Creech; Sharon E Frey; Christopher J Harrison; Mary Staat; Evan J Anderson; Susan Dulkerian; Isaac P Thomsen; Mohamad Al-Hosni; Barbara A Pahud; David I Bernstein; Jumi Yi; Joshua E Petrikin; Beth Haberman; Kathy Stephens; Ina Stephens; Randolph E Oler; Tom M Conrad Journal: Pediatrics Date: 2019-01 Impact factor: 7.124
Authors: Ibukunoluwa C Akinboyo; Annie Voskertchian; Gezahegn Gorfu; Joshua F Betz; Tracy L Ross; Karen C Carroll; Aaron M Milstone Journal: Infect Control Hosp Epidemiol Date: 2018-09-18 Impact factor: 3.254
Authors: Ricardo A Murcia; Sandra M Leal; Martha V Roa; Edgar Nagles; Alvaro Muñoz-Castro; John J Hurtado Journal: Molecules Date: 2018-08-13 Impact factor: 4.411