Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Impact of active surveillance and decolonization strategies for methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To assess the impact of active surveillance and decolonization strategies on methicillin-resistant Staphylococcus aureus (MRSA) infection rates in a NICU.

Study design

MRSA infection rates were compared before (2014–2016) and during (2017–2022) an active surveillance program. Eligible infants were decolonized with chlorohexidine gluconate (CHG) bathing and/or topical mupirocin. Successful decolonization and rates of recolonization were assessed.

Results

Fifty-two (0.57%) of 9 100 hospitalized infants had invasive MRSA infections from 2014 to 2022; infection rates declined non-significantly. During the 6-year surveillance program, the risk of infection was 16.9-times [CI95 8.4, 34.1] higher in colonized infants than uncolonized infants. Those colonized with mupirocin-susceptible MRSA were more likely successfully decolonized (aOR 9.7 [CI95 4.2, 22.5]). Of 57 infants successfully decolonized who remained hospitalized, 34 (60%) became recolonized.

Conclusions

MRSA infection rates did not significantly decline in association with an active surveillance and decolonization program. Alternatives to mupirocin and CHG are needed to facilitate decolonization.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: MRSA invasive infections, January 2014–December 2022.
Fig. 2: Incidence and prevalence of MRSA colonization during the active surveillance program, January 2017–December 2022.
Fig. 3: Study population flow diagram of MRSA colonization, decolonization, and recolonization during the active surveillance program, January 2017–December 2022.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to privacy concerns, but could be made available from the corresponding author on reasonable request and with the permission of the Columbia University Irving Medical Center IRB.

References

  1. Centers for Disease Control and Prevention. Recommendations for Prevention and Control of Infections in NICU patients: S. aureus. [Internet]. cdc.gov; 2020. Accessed February 2023. https://www.cdc.gov/infectioncontrol/guidelines/nicu-saureus/introduction.html

  2. Nelson MU, Gallagher PG. Methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit. Semin Perinatol. 2012;36:424–30.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Karchmer TB, Durbin LJ, Simonton BM, Farr BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2002;51:126–32.

    Article  CAS  PubMed  Google Scholar 

  4. Schuetz CR, Hogan PG, Reich PJ, Halili S, Wiseman HE, Boyle MG, et al. Factors associated with progression to infection in methicillin-resistant Staphylococcus aureus-colonized, critically ill neonates. J Perinatol. 2021;41:1285–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Maraqa NF, Aigbivbalu L, Masnita-Iusan C, Wludyka P, Shareef Z, Bailey C, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control. 2011;39:35–41.

    Article  PubMed  Google Scholar 

  6. Zervou FN, Zacharioudakis IM, Ziakas PD, Mylonakis E. MRSA colonization and risk of infection in the neonatal and pediatric ICU: a meta-analysis. Pediatrics. 2014;133:e1015–1023.

    Article  PubMed  Google Scholar 

  7. Huang YC, Chou YH, Su LH, Lien RI, Lin TY. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics. 2006;118:469–74.

    Article  PubMed  Google Scholar 

  8. Sakaki H, Nishioka M, Kanda K, Takahashi Y. An investigation of the risk factors for infection with methicillin-resistant Staphylococcus aureus among patients in a neonatal intensive care unit. Am J Infect Control. 2009;37:580–6.

    Article  PubMed  Google Scholar 

  9. Pierce R, Lessler J, Popoola VO, Milstone AM. Methicillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme. J Hosp Infect. 2017;95:91–97.

    Article  CAS  PubMed  Google Scholar 

  10. Kotloff KL, Shirley DT, Creech BC, Frey SE, Harrison CJ, Staat M, et al. Mupirocin for Staphylococcus aureus decolonization of infants in neonatal intensive care units. Pediatrics. 2019;143:e20181565.

    Article  PubMed  Google Scholar 

  11. Goldstein ND, Jenness SM, Tuttle D, Power M, Paul DA, Eppes SC. Evaluating a neonatal intensive care unit MRSA surveillance programme using agent-based network modelling. J Hosp Infect. 2018;100:337–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Geva A, Wright SB, Baldini LM, Smallcomb JA, Safran C, Gray JE. Spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: Network analysis. Pediatrics. 2011;128:e1173–1180.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nelson MU, Shaw J, Gross SJ. Randomized placebo-controlled trial of topical mupirocin to reduce Staphylococcus aureus colonization in infants in the neonatal intensive care unit. J Pediatr. 2021;236:70–77.

    Article  CAS  PubMed  Google Scholar 

  14. Milstone AM, Budd A, Shepard JW, Ross T, Aucott S, Carroll KC. Role of decolonization in a comprehensive strategy to reduce methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit: an observational cohort. Infect Control Hosp Epidemiol. 2010;31:558–60.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bozzella MJ, Soghier L, Harris T, Zell L, Short BL, Song X. Impact of decolonization on methicillin-resistant Staphylococcus aureus transmission and infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2019;40:1123–7.

    Article  PubMed  Google Scholar 

  16. Popoola VO, Budd A, Wittig SM, Ross T, Aucott SW, Perl TM, et al. Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention. Infect Control Hosp Epidemiol. 2014;35:412–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Grohs E, Hill-Ricciuti A, Kelly N, Messina M, Green DA, Geng W, et al. Spa typing of Staphylococcus aureus in a neonatal intensive care unit during routine surveillance. J Pediatr Infect Dis Soc. 2021;10:766–73.

    Article  CAS  Google Scholar 

  18. Saiman L, Acker KP, Dumitru D, Messina M, Johnson C, Zachariah P, et al. Infection prevention and control for labor and delivery, well baby nurseries, and neonatal intensive care units. Semin Perinatol. 2020;44:151320.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Macnow T, O’Toole D, DeLaMora P, Murray M, Rivera K, Whittier S, et al. Utility of surveillance cultures for antimicrobial resistant organisms in infants transferred to the NICU. Pediatr Infect Dis J. 2013;32:e443–e450.

    Article  PubMed  Google Scholar 

  20. Carey AJ, Della-Latta P, Huard R, Wu F, Graham PL, Carp D, et al. Changes in the molecular epidemiology of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2010;31:613–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Swenson JM, Wong B, Simor AE, Thomson RB, Ferraro MJ, Hardy DJ, et al. Multicenter study to determine disk diffusion and broth microdilution criteria for prediction of high- and low-level mupirocin resistance in Staphylococcus aureus. J Clin Microbiol. 2010;48:2469–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. National Healthcare Safety Network. CDC/NHSN Surveillance Definitions for Specific Types of Infections [Internet]. cdc.gov; 2023. Accessed February 2023. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf

  23. National Healthcare Safety Network. Surgical Site Infection Event (SSI) [Internet]. cdc.gov; 2023. Accessed February 2023. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf

  24. National Healthcare Safety Network. Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) Events. Accessed February 2023. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf

  25. National Healthcare Safety Network. Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) Event. Accessed February 2023. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf

  26. Baker MA, Sands KE, Huang SS, Kleinman K, Septimus EJ, Varma N, et al. The impact of COVID-19 on healthcare-associated infections. Clin Infect Dis. 2022;74:1748–54.

    Article  CAS  PubMed  Google Scholar 

  27. Lastinger LM, Alvarez CR, Kofman A, Konnor RY, Kuhar DT, Nkwata A, et al. Continued increases in the incidence of healthcare-associated infection (HAI) during the second year of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2023;44:997–1001.

    Article  PubMed  Google Scholar 

  28. Balamohan A, Beachy J, Kohn N, Rubin LG. The effect of routine surveillance and decolonization on the rate of Staphylococcus aureus infections in a level IV neonatal intensive care unit. J Perinatol. 2020;40:1644–51.

    Article  CAS  PubMed  Google Scholar 

  29. Jernigan JA, Titus MG, Groschel DHM, Getchell-White SI, Farr BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol. 1996;143:496–504.

    Article  CAS  PubMed  Google Scholar 

  30. Hetem DJ, Bonten MJ. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect. 2013;85:249–56.

    Article  CAS  PubMed  Google Scholar 

  31. Kamity R, Hanna Z. Chlorhexidine baths in preterm infants - are we there yet? J Perinatol. 2019;39:1014–5.

    Article  PubMed  Google Scholar 

  32. Bhalla A, Aron DC, Donskey CJ. Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureus on skin of hospitalized patients. BMC Infect Dis. 2007;7:105.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ringberg H, Petersson AC, Walder M, Johansson PJH. The throat: an important site for MRSA colonization. Scand J Infect Dis. 2006;38:888–93.

    Article  PubMed  Google Scholar 

  34. Reeves L, Barton L, Nash M, Williams J, Guimera D, Simmons B, et al. Effectiveness of an alcohol-based nasal antiseptic in reducing MRSA bacteremia in an adult intensive care population. Infect Control Hosp Epidemiol. 2020;41:s206.

    Article  Google Scholar 

  35. Steed LL, Costello J, Lohia S, Jones T, Spannhake EW, Nguyen S. Reduction of nasal Staphylococcus aureus carriage in health care professionals by treatment with a nonantibiotic, alcohol-based nasal antiseptic. Am J Infect Control. 2014;42:841–6.

    Article  CAS  PubMed  Google Scholar 

  36. Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother. 2015;7:2681–92.

    Article  Google Scholar 

  37. Akinboyo IC, Voskertchian A, Gorfu G, Betz J, Ross T, Carroll KC, et al. Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU. Infect Control Hosp Epidemiol. 2019;39:1334–9.

    Article  Google Scholar 

  38. Advani SD, Murray TS, Murdzek CM, Aniskiewicz MJ, Bizzarro MJ. Shifting focus toward healthcare-associated bloodstream infections: The need for neonatal intensive care unit–specific NHSN definitions. Infect Control Hosp Epidemiol. 2019;41:181–6.

    Google Scholar 

  39. Paul AA, Gentzler E, Solowey K, Manickam S, Frantzis I, Alba L, et al. Epidemiology, risk factors, and applicability of CDC definitions for healthcare-associated bloodstream infections at a level IV neonatal ICU. J Perinatol. 2023;43:1152–7.

    Article  PubMed  Google Scholar 

  40. Akinboyo IC, Zangwill KM, Berg WM, Cantey JB, Huizinga B, Milstone AM. SHEA neonatal intensive care unit (NICU) white paper series: practical approaches to Staphylococcus aureus disease prevention. Infect Control Hosp Epidemiol. 2020;41:1251–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the neonatal intensive care unit teams for obtaining the surveillance swabs and implementing the decolonization strategies.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA

    Sonia Gollerkeri, Anshu A. Paul, Alexandra Hill-Ricciuti, Rakesh Sahni & Lisa Saiman

  2. Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA

    Caroline Oliver & Barun Mathema

  3. Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA

    Messina Maria & Lisa Saiman

  4. Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA

    Daniel A. Green & Fann Wu

Authors
  1. Sonia Gollerkeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caroline Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Messina Maria
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel A. Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fann Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anshu A. Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexandra Hill-Ricciuti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Barun Mathema
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rakesh Sahni
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lisa Saiman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SG conducted primary data collection and analysis and wrote the first draft of the manuscript. CO conducted primary data collection and analysis and critically reviewed the manuscript. MM supervised collection of surveillance swabs, conducted primary data collection for colonization results and infections, and critically reviewed the manuscript. DAG supervised surveillance culture processing and interpretation and critically reviewed the manuscript. FW assisted with surveillance cultures, performed and analyzed pulsed field gel electrophoresis and critically reviewed the manuscript. AP assisted in data interpretation and critically reviewed the manuscript. BM assisted with the data analysis plan and critically reviewed the manuscript. AHR assisted with the data analysis plan and critically reviewed the manuscript. RS supervised implementation of decolonization efforts and critically reviewed the manuscript. LS conceived the study, reviewed the data collection and analysis plan, and edited the manuscript.

Corresponding author

Correspondence to Lisa Saiman.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gollerkeri, S., Oliver, C., Maria, M. et al. Impact of active surveillance and decolonization strategies for methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01902-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41372-024-01902-w

Search

Advanced search

Quick links