Archana Balamohan1, Joanna Beachy2, Nina Kohn3, Lorry G Rubin2. 1. Cohen Children's Medical Center of New York, New York, NY. Electronic address: abalamohan@uams.edu. 2. Cohen Children's Medical Center of New York, New York, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. 3. Biostatistics Unit, Feinstein Institute of Medical Research, Manhasset, NY.
Abstract
AIM: To determine risk factors for MRSA colonization in a Level IV Neonatal Intensive Care Unit (NICU) independent of length of stay and gestational age in the context of a persistently circulating MRSA clone. DESIGN: Retrospective matched case-control study. SETTING: Level IV NICU PATIENTS: Infants admitted between April 4,2017- March 31,2018. METHODS: Based on weekly surveillance cultures, infants who acquired MRSA were matched 1:1 with MRSA-negative control infants by duration of exposure (length of stay) and gestational age to determine risk factors for acquisition. RESULTS: Fifty case infants were matched with controls. Isolates from 45 of the 50 cases were mupirocin-resistant and related by pulse-field gel electrophoresis. On matched univariable analysis, the following were significantly associated with a risk for MRSA acquisition: 1.Bed location in the acute area(p=0.03), 2.Requirement of any level of respiratory support during the week prior to MRSA detection(p=0.04), 3.Higher ATP pass rate (a measure of effectiveness of cleaning) during the week of and week prior(p=0.01), 4.Higher MRSA colonization pressure during the week of and week prior(p<0.0001), 5.Not having a hearing test during the time between the previous negative culture and MRSA acquisition(p=0.01). A multivariable conditional logistic regression model (that excluded ATP pass rate) found that only colonization pressure was associated with acquisition of MRSA colonization. CONCLUSIONS: In an outbreak setting, MRSA colonization pressure is significantly associated with MRSA acquisition in the NICU independent of length of stay and gestational age.
AIM: To determine risk factors for MRSA colonization in a Level IV Neonatal Intensive Care Unit (NICU) independent of length of stay and gestational age in the context of a persistently circulating MRSA clone. DESIGN: Retrospective matched case-control study. SETTING: Level IV NICU PATIENTS: Infants admitted between April 4,2017- March 31,2018. METHODS: Based on weekly surveillance cultures, infants who acquired MRSA were matched 1:1 with MRSA-negative control infants by duration of exposure (length of stay) and gestational age to determine risk factors for acquisition. RESULTS: Fifty case infants were matched with controls. Isolates from 45 of the 50 cases were mupirocin-resistant and related by pulse-field gel electrophoresis. On matched univariable analysis, the following were significantly associated with a risk for MRSA acquisition: 1.Bed location in the acute area(p=0.03), 2.Requirement of any level of respiratory support during the week prior to MRSA detection(p=0.04), 3.Higher ATP pass rate (a measure of effectiveness of cleaning) during the week of and week prior(p=0.01), 4.Higher MRSA colonization pressure during the week of and week prior(p<0.0001), 5.Not having a hearing test during the time between the previous negative culture and MRSA acquisition(p=0.01). A multivariable conditional logistic regression model (that excluded ATP pass rate) found that only colonization pressure was associated with acquisition of MRSA colonization. CONCLUSIONS: In an outbreak setting, MRSA colonization pressure is significantly associated with MRSA acquisition in the NICU independent of length of stay and gestational age.