Year 2019, Volume 14, Issue 4, Pages 263 - 269 2019-07-30

Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit
Üçüncü basamak bir yenidoğan yoğun bakım ünitesinde metisilin dirençli Staphylococcus aureus kan dolaşımı enfeksiyonlarının görülme sıklığı ve risk faktörleri

Ferit Kulalı [1] , Ahmet Yagmur Bas [2] , Sara Erol [3] , Husniye Yucel [4] , Deniz Yaprak [5] , İlter Arifoglu [6] , Nihal Demirel [7]

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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.

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.

  • 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.
Primary Language en
Subjects General and Internal Medicine
Journal Section ORIGINAL ARTICLES
Authors

Orcid: 0000-0003-0310-1184
Author: Ferit Kulalı (Primary Author)
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Orcid: 0000-0002-1329-2167
Author: Ahmet Yagmur Bas
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Orcid: 0000-0002-8758-7662
Author: Sara Erol
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Orcid: 0000-0002-7477-0302
Author: Husniye Yucel
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Orcid: 0000-0002-8130-7877
Author: Deniz Yaprak
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Orcid: 0000-0001-6254-751X
Author: İlter Arifoglu
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Orcid: 0000-0003-2044-2212
Author: Nihal Demirel
Institution: UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES
Country: Turkey


Dates

Publication Date: July 30, 2019

Bibtex @research article { tchd542092, journal = {Türkiye Çocuk Hastalıkları Dergisi}, issn = {1307-4490}, eissn = {2148-3566}, address = {Sağlık Bilimleri Üniversitesi}, year = {2019}, volume = {14}, pages = {263 - 269}, doi = {10.12956/tchd.542092}, title = {Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit}, key = {cite}, author = {Kulalı, Ferit and Bas, Ahmet Yagmur and Erol, Sara and Yucel, Husniye and Yaprak, Deniz and Arifoglu, İlter and Demirel, Nihal} }
APA Kulalı, F , Bas, A , Erol, S , Yucel, H , Yaprak, D , Arifoglu, İ , Demirel, N . (2019). Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit. Türkiye Çocuk Hastalıkları Dergisi, 14 (4), 263-269. DOI: 10.12956/tchd.542092
MLA Kulalı, F , Bas, A , 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 Hastalıkları Dergisi 14 (2019): 263-269 <http://dergipark.org.tr/tchd/issue/47759/542092>
Chicago Kulalı, F , Bas, A , 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 Hastalıkları Dergisi 14 (2019): 263-269
RIS TY - JOUR T1 - Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit AU - Ferit Kulalı , Ahmet Yagmur Bas , Sara Erol , Husniye Yucel , Deniz Yaprak , İlter Arifoglu , Nihal Demirel Y1 - 2019 PY - 2019 N1 - doi: 10.12956/tchd.542092 DO - 10.12956/tchd.542092 T2 - Türkiye Çocuk Hastalıkları Dergisi JF - Journal JO - JOR SP - 263 EP - 269 VL - 14 IS - 4 SN - 1307-4490-2148-3566 M3 - doi: 10.12956/tchd.542092 UR - https://doi.org/10.12956/tchd.542092 Y2 - 2019 ER -
EndNote %0 Turkish Journal of Pediatric Disease Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit %A Ferit Kulalı , Ahmet Yagmur Bas , Sara Erol , Husniye Yucel , Deniz Yaprak , İlter Arifoglu , Nihal Demirel %T Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit %D 2019 %J Türkiye Çocuk Hastalıkları Dergisi %P 1307-4490-2148-3566 %V 14 %N 4 %R doi: 10.12956/tchd.542092 %U 10.12956/tchd.542092
ISNAD Kulalı, Ferit , Bas, Ahmet Yagmur , Erol, Sara , Yucel, Husniye , Yaprak, Deniz , Arifoglu, İlter , Demirel, Nihal . "Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit". Türkiye Çocuk Hastalıkları Dergisi 14 / 4 (July 2019): 263-269. https://doi.org/10.12956/tchd.542092
AMA Kulalı F , Bas A , 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; 14(4): 263-269.
Vancouver Kulalı F , Bas A , 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 Hastalıkları Dergisi. 2019; 14(4): 269-263.