Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Am J Infect Control. 2015 May 1;43(5):476-81. doi: 10.1016/j.ajic.2014.12.027. Epub 2015 Feb 25.


Objective: To describe epidemiologic features and identify risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in a level III neonatal intensive care unit (NICU).

Setting: A prospective, cohort study in a university-affiliated NICU with an infection control program including weekly nasal cultures of all neonates.

Methods: Demographic, clinical, and microbiologic data were prospectively collected between June 2009 and June 2013. Molecular characterization of MRSA isolates was done by multilocus variable number tandem repeat fingerprinting, staphylococcal cassette chromosome mec typing, and on representative isolates by multilocus sequence typing and spa typing.

Results: Of 949 neonates, 217 (22.87%) had a culture growing MRSA, including 117 neonates testing positive at their first sampling. Of these latter infants, 96 (82.05%) were inborn and 59 (50.43%) had been transferred from the nursery. Length of stay and colonization pressure were strong independent predictors of MRSA acquisition. Among MRSA isolates, 7 sequence types were identified, with ST22-IVa, spa type t223, being the predominant strain.

Conclusions: In an endemic area, early MRSA acquisition and high colonization pressure, likely related to an influx of colonized infants from a well-infant nursery, can support persistence of MRSA in NICUs. Surveillance, molecular tracking of strains, and reinforcement of infection control practices, involving well-infant nurseries in a comprehensive infection control program, could be helpful in containing MRSA transmission.

Keywords: Active surveillance; Colonization pressure; Infection control.

MeSH terms

  • Carrier State / epidemiology*
  • Carrier State / microbiology
  • Cohort Studies
  • Female
  • Genotype
  • Hospitals, University
  • Humans
  • Incidence
  • Infant, Newborn
  • Intensive Care Units, Neonatal*
  • Male
  • Methicillin-Resistant Staphylococcus aureus / classification
  • Methicillin-Resistant Staphylococcus aureus / genetics
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Molecular Epidemiology
  • Molecular Typing
  • Nasal Mucosa / microbiology*
  • Prospective Studies
  • Risk Factors
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology