Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel
-
Published:2022-06-16
Issue:4
Volume:44
Page:589-596
-
ISSN:0899-823X
-
Container-title:Infection Control & Hospital Epidemiology
-
language:en
-
Short-container-title:Infect. Control Hosp. Epidemiol.
Author:
Quan Kathleen A.ORCID, Sater Mohamad R. A.ORCID, Uy CherryORCID, Clifton-Koeppel RobinORCID, Dickey Linda L., Wilson William, Patton Pat, Chang Wayne, Samuelson Pamela, Lagoudas Georgia K.ORCID, Allen Teri, Merchant Lenny, Gannotta Rick, Bittencourt Cassiana E., Soto J. C., Evans Kaye D., Blainey Paul C.ORCID, Murray John, Shelton Dawn, Lee Helen S., Zahn Matthew, Wolfe Julia, Madey Keith, Yim Jennifer, Gohil Shruti K., Grad Yonatan H.ORCID, Huang Susan S.ORCID
Abstract
AbstractObjective:To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.Design:Prospective observational study.Setting:Neonatal intensive care unit (NICU).Methods:We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.Results:A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.Conclusions:In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.
Publisher
Cambridge University Press (CUP)
Subject
Infectious Diseases,Microbiology (medical),Epidemiology
Reference21 articles.
1. Rapid Whole-Genome Sequencing for Investigation of a Neonatal MRSA Outbreak 2. Lack of Comprehensive Outbreak Detection in Hospitals 3. Healthcare worker-related MRSA cluster in a German neonatology level III ICU: A true European story 4. 2. Principles of Epidemiology in Public Health Practice, Third Edition. Lesson 1: Introduction to applied epidemiology and biostatistics. Centers for Disease Control and Prevention website. https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html. Published 2012. Accessed May 31, 2022. 5. 21. The microbiology laboratory database software. WHONET website. https://www.whonet.org/. Accessed April 24, 2021.
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
1. Antipathogenic coating agents to improve the innate hand-barrier mechanism;Environmental Technology & Innovation;2023-11 2. Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology;Italian Journal of Pediatrics;2023-09-08 3. Collateral impacts of pandemic COVID-19 drive the nosocomial spread of antibiotic resistance: A modelling study;PLOS Medicine;2023-06-05 4. Collateral impacts of pandemic COVID-19 drive the nosocomial spread of antibiotic resistance;2022-08-16
|
|