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Üçüncü basamak bir yenidoğan yoğun bakım ünitesinde metisilin dirençli Staphylococcus aureus kan dolaşımı enfeksiyonlarının görülme sıklığı ve risk faktörleri

Year 2019, Volume: 13 Issue: 4, 263 - 269, 30.07.2019
https://doi.org/10.12956/tchd.542092

Abstract

Giriş:
Metisilin dirençli Staphylococcus Aureus
(MRSA) infeksiyonları, yenidoğan yoğun bakım ünitesi (NICU)’ndeki hastalar için
önemli bir morbidite ve motalite nedenidir. MRSA enfeksiyonlarının gelişimine
zemin hazırlayan risk faktörlerinin belirlenmesi, enfeksiyonların önlenmesi
açısından son derece önemlidir.



Bu çalışmada, MRSA
enfeksiyonlarına ait risk faktörlerini saptamayı amaçladık.



Gereç
ve Yöntemler:
Bu retrospektif çalışma,
1 Ocak 2011 – 31 Aralık 2015 takvim yılları arasında üçüncü basamak bir NICU’da
yapıldı. Çalışmaya, kan kültürülerinde Staphylococcus
Aureus (S. aureus)
izole edilen tüm hastalar alındı. Antibiyogram sonucuna
göre, hastalar iki gruba ayrıldı: MRSA ve metisilin duyarlı S. aureus (MSSA). Hastaların demografik
özellikleri ile klinik ve laboratuvar bulguları dökümente edildi.



Bulgular:
NICU’ya kabul edilen 9864 hastanın 54’ünde S.
aureus
enfeksiyonu saptandı. S.
aureus
enfeksiyonları, 1500 gr altındaki infantlarda (35 of 1542 infants),
1500 gr ve üzerindeki infantlara (19 of 8322 infants) göre daha sık görülmekte
idi [p<0.001 IRR=9.94 CI=(5.69 - 17.39)]. Olguların % 79.6 (43 of 54)’ında
MSSA, % 20.4 (11 of 54)’ünde ise MRSA suşları tespit edildi. MRSA
enfeksiyonları 1500 gr ve altındaki bebeklerde 1500 gr ve üstü bebeklerden daha
sık görülmesine rağmen, MRSA enfeksiyonları ile doğum ağırlığı arasında
istatistiksel olarak anlamlı bir ilişki saptanmadı. Doğum ağırlığı, gebelik
yaşı, cinsiyet, SNAPPE skoru, tedavi yöntemleri (santral venöz kateter, total
parenteral beslenme, yardımlı ventilasyon) ve kullanılan antibiyotikler (prenatal
veya ampirik) metisilin direnci açısından anlamlı bir fark oluşturmadı.



Tartışma:
S. aureus enfeksiyonları için en
önemli risk faktörü, çok düşük doğum ağırlığına (<1500 gr) sahip olmaktır.

References

  • 1) Thaden JT, Ericson JE, Cross H, Bergin SP, Messina JA, et al. Survival benefit of empirical therapy for Staphylococcus aureus bloodstream infections in infants. Pediatr Infect Dis J 2015;34:1175-1179.
  • 2) Ericson JE, Popoola VO, Smith PB, Benjamin DK, Fowler VG, Clark RH, et al. Burden of invasive Staphylococcus aureus infections in hospitalized infants. JAMA Pediatr 2015;169:1105-1111.
  • 3) Nelson MU, Gallagher PG. Methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit. Semin Perinatol 2012;36:424-430.
  • 4) Nelson MU, Bizzarro MJ, Baltimore RS, Dembry LM, Gallagher PG. Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in the decade following implementation of an active detection and isolation program. J Clin Microbiol 2015;53:2492-2501.
  • 5) Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970-1978.
  • 6) Blanchard AC, Quach C, Autmizguine J. Staphylococcal infections in infants: updates and current challenges. Clin Perinatol 2015;42:119-132.
  • 7) Carey A, Duchon J, Della-Latta P, Saiman L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000–2007. J Perinatol 2010;30:135-139.
  • 8) Gerber SI, Jones RC, Scott MV, Price JS, Dworkin MS, Filippell MB, et al. Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006;27:139-145.
  • 9) Huang Y-C, Chou Y-H, Su L-H, Lien R-I, Lin T-Y. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics 2006;118:469-474.
  • 10) Khoury J, Jones M, Grim A, Dunne WM, Fraser V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26:616-621.
  • 11) 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: 580-586.
  • 12) Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001;138:92-100.
  • 13) Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010;125:2009-0913.
  • 14) Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7.
  • 15) Papile L-A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-534.
  • 16) Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-1729.
  • 17) Wayne P. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing 2007; 17.
  • 18) Huskins W, Goldmann D. Prevention and control of nosocomial infections in health care facilities that serve children. Hospital control of infections. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds). Textbook of Pediatric Infectious Diseases Philadelphia: Saunders, 2004: 2924-2941.
  • 19) Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008;36:e1-e12.
  • 20) Kempley S, Kapellou O, McWilliams A, Banerjee J, McCorqodale A, Millar M. Antibiotic treatment duration and prevention of complications in neonatal Staphylococcus aureus bacteraemia. J Hosp Infect 2015;91:129-135.
  • 21) Saiman L, Cronquist A, Wu F, Zhou J, Rubenstein D, Eisner W, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317-321.
  • 22) Morel A-S, Wu F, Della-Latta P, Cronquist A, Rubenstein D, Saiman L. Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants. Am J Infect Control 2002;30:170-173.
  • 23) Regev-Yochay G, Rubinstein E, Barzilai A, Carmeli Y, Kuint J, Etienne J, et al. Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit. Emerg Infect Dis 2005;11:453-456.
  • 24) Williams K, Hopkins S, Turbitt D, Seng C, Cooksone B, Patel BC, et al. Survey of neonatal unit outbreaks in North London: identifying causes and risk factors. J Hosp Infect 2014;88:149-155.
  • 25) Frederiksen MS, Espersen F, Frimodt-Møller N, Jensen AG, Larsen AR, Pallesen LV, et al. Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000. Pediatr Infect Dis J 2007;26:398-405.
  • 26) Suryati B, Watson M. Staphylococcus aureus bacteraemia in children: a 5‐year retrospective review. J Paediatr Child Health 2002;38:290-294.
  • 27) Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003;167:695-701.
  • 28) Burke RE, Halpern MS, Baron EJ, Gutierrez K. Pediatric and Neonatal Staphylococcus aureus Bacteremia Epidemiology, Risk Factors, and Outcome. Infect Control Hosp Epidemiol 2009;30:636-644.

Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit

Year 2019, Volume: 13 Issue: 4, 263 - 269, 30.07.2019
https://doi.org/10.12956/tchd.542092

Abstract

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) infections
are significant causes of morbidity and mortality for the patients in neonatal
intensive care unit (NICU). The identification of risk factors that lead up to
the development of MRSA infections is of utmost importance in terms of preventing
infections.

In this study, we
aim to determine the risk factors of MRSA infections.

Material and Methods: This retrospective study
was conducted in a tertiary NICU between 1stJanuary 2011 and 31stDecember
2015. All patients with S. aureus
isolated from blood cultures were included in the study. According to the
antibiogram pattern, the patients were separated into two groups: MRSA and
methicillin-susceptible Staphylococcus aureus
(MSSA).

Results: S.
aureus
infections were more frequent in infants
under 1500 g (2.27%) than in infants of 1500 g and above (0.23%) [OR=10.149,
CI: 5.790-17.790, p<0.001]. MSSA was identified in 79.6% (43 of 54) of
cases, and MRSA strains were identified in 20.4% (11 of 54) of cases. Although,
MRSA infections were more frequent in infants under 1500 g than in infants of
1500 g and above, there was no statistically significant association between
MRSA and birth weight [OR=1.580, CI: 0.366-6.831, p=0.728]. We found that birth
weight, gestational age, sex, SNAPPE score, therapeutic procedures (central
venous catheter, total parenteral nutrition, assisted ventilation) and
antibiotics used (prenatal or empirical) did not make a significant difference
in terms of methicillin resistance.









Conclusion: Very low birth weight is
the most important risk factor for both S.
aureus
infections.

References

  • 1) Thaden JT, Ericson JE, Cross H, Bergin SP, Messina JA, et al. Survival benefit of empirical therapy for Staphylococcus aureus bloodstream infections in infants. Pediatr Infect Dis J 2015;34:1175-1179.
  • 2) Ericson JE, Popoola VO, Smith PB, Benjamin DK, Fowler VG, Clark RH, et al. Burden of invasive Staphylococcus aureus infections in hospitalized infants. JAMA Pediatr 2015;169:1105-1111.
  • 3) Nelson MU, Gallagher PG. Methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit. Semin Perinatol 2012;36:424-430.
  • 4) Nelson MU, Bizzarro MJ, Baltimore RS, Dembry LM, Gallagher PG. Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in the decade following implementation of an active detection and isolation program. J Clin Microbiol 2015;53:2492-2501.
  • 5) Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970-1978.
  • 6) Blanchard AC, Quach C, Autmizguine J. Staphylococcal infections in infants: updates and current challenges. Clin Perinatol 2015;42:119-132.
  • 7) Carey A, Duchon J, Della-Latta P, Saiman L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000–2007. J Perinatol 2010;30:135-139.
  • 8) Gerber SI, Jones RC, Scott MV, Price JS, Dworkin MS, Filippell MB, et al. Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006;27:139-145.
  • 9) Huang Y-C, Chou Y-H, Su L-H, Lien R-I, Lin T-Y. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics 2006;118:469-474.
  • 10) Khoury J, Jones M, Grim A, Dunne WM, Fraser V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26:616-621.
  • 11) 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: 580-586.
  • 12) Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001;138:92-100.
  • 13) Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010;125:2009-0913.
  • 14) Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7.
  • 15) Papile L-A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-534.
  • 16) Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-1729.
  • 17) Wayne P. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing 2007; 17.
  • 18) Huskins W, Goldmann D. Prevention and control of nosocomial infections in health care facilities that serve children. Hospital control of infections. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds). Textbook of Pediatric Infectious Diseases Philadelphia: Saunders, 2004: 2924-2941.
  • 19) Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008;36:e1-e12.
  • 20) Kempley S, Kapellou O, McWilliams A, Banerjee J, McCorqodale A, Millar M. Antibiotic treatment duration and prevention of complications in neonatal Staphylococcus aureus bacteraemia. J Hosp Infect 2015;91:129-135.
  • 21) Saiman L, Cronquist A, Wu F, Zhou J, Rubenstein D, Eisner W, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317-321.
  • 22) Morel A-S, Wu F, Della-Latta P, Cronquist A, Rubenstein D, Saiman L. Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants. Am J Infect Control 2002;30:170-173.
  • 23) Regev-Yochay G, Rubinstein E, Barzilai A, Carmeli Y, Kuint J, Etienne J, et al. Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit. Emerg Infect Dis 2005;11:453-456.
  • 24) Williams K, Hopkins S, Turbitt D, Seng C, Cooksone B, Patel BC, et al. Survey of neonatal unit outbreaks in North London: identifying causes and risk factors. J Hosp Infect 2014;88:149-155.
  • 25) Frederiksen MS, Espersen F, Frimodt-Møller N, Jensen AG, Larsen AR, Pallesen LV, et al. Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000. Pediatr Infect Dis J 2007;26:398-405.
  • 26) Suryati B, Watson M. Staphylococcus aureus bacteraemia in children: a 5‐year retrospective review. J Paediatr Child Health 2002;38:290-294.
  • 27) Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003;167:695-701.
  • 28) Burke RE, Halpern MS, Baron EJ, Gutierrez K. Pediatric and Neonatal Staphylococcus aureus Bacteremia Epidemiology, Risk Factors, and Outcome. Infect Control Hosp Epidemiol 2009;30:636-644.
There are 28 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Ferit Kulalı 0000-0003-0310-1184

Ahmet Yagmur Bas 0000-0002-1329-2167

Sara Erol 0000-0002-8758-7662

Husniye Yucel 0000-0002-7477-0302

Deniz Yaprak 0000-0002-8130-7877

İlter Arifoglu This is me 0000-0001-6254-751X

Nihal Demirel 0000-0003-2044-2212

Publication Date July 30, 2019
Submission Date March 19, 2019
Published in Issue Year 2019 Volume: 13 Issue: 4

Cite

Vancouver Kulalı F, Bas AY, Erol S, Yucel H, Yaprak D, Arifoglu İ, Demirel N. Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit. Türkiye Çocuk Hast Derg. 2019;13(4):263-9.


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