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

Journal of Perinatology volume 44, pages 724–730 (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.

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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.

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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.

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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

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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.

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Correspondence to Lisa Saiman.

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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 44, 724–730 (2024). https://doi.org/10.1038/s41372-024-01902-w

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