S.aureus is the second most common pathogen causing late onset septicemia in neonatal intensive care units particularly in premature infants with very low birth weight. Poorly developed host defence mechanisms, the necessity for central venous catheters, invasive procedures, poor skin integrity, prolonged total parenteral nutrition, and the use of steroids or antimicrobial agents all increase the risk of staphylococcal infection in premature infants.
We describe the changing epidemiology of Staphylococcus aureus infections in NICU at Leeds over 2008–2013 using laboratory and clinical data.
Leeds Neonatal Service experienced an increased number of cases of Meticillin resistant Staphylococcus aureus (MRSA) colonisation and bacteraemia in 2008–2009. A series of infection control interventions were implemented stepwise including;
adoption of the Saving Lives central venous catheter package,
daily antiseptic skin washes in neonates >28weeks and
2% Chlorhexidine for skin asepsis prior to invasive procedures.
There has been a noticeable success in reduction in MRSA infections and no bacteraemia has been reported since 2009. However, a similar sustained improvement has not been seen in Meticillin sensitive Staphylococcus aureus (MSSA) bacteraemia. A retrospective review was carried out to review MSSA bacteraemia since 2008: 71% cases were seen in neonates under 28weeks (27/38), a vulnerable patient cohort currently excluded from daily skin washes.
Given an association between MSSA colonisation and infection, further work should investigate infection control strategies that effectively target the highest risk groups and include active surveillance for MSSA and MRSA with subsequent decolonisation.
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