Highlights
- •Persistently circulating MRSA clone in NICU.
- •Risk factors for MRSA colonization, independent of length of stay & gestational age.
- •Colonization pressure, lower ATP pass rate are associated with acquisition of colonization.
- •Higher acuity of care is also associated with acquisition of colonization.
- •In a multivariable model, only colonization pressure was significantly associated.
Aim
To determine risk factors for MRSA colonization in a Level IV Neonatal Intensive Care
Unit (NICU) independent of length of stay and gestational age in the context of a
persistently circulating MRSA clone.
Design
Retrospective matched case-control study.
Setting
Level IV NICU
Patients
Infants admitted between April 4,2017- March 31,2018.
Methods
Based on weekly surveillance cultures, infants who acquired MRSA were matched 1:1
with MRSA-negative control infants by duration of exposure (length of stay) and gestational
age to determine risk factors for acquisition.
Results
Fifty case infants were matched with controls. Isolates from 45 of the 50 cases were
mupirocin-resistant and related by pulse-field gel electrophoresis. On matched univariable
analysis, the following were significantly associated with a risk for MRSA acquisition:
1.Bed location in the acute area(P = 0.03), 2.Requirement of any level of respiratory support during the week prior
to MRSA detection(P = 0.04), 3.Higher ATP pass rate (a measure of effectiveness of cleaning) during the
week of and week prior(P = 0.01), 4.Higher MRSA colonization pressure during the week of and week prior(P< 0.0001), 5.Not having a hearing test during the time between the previous negative
culture and MRSA acquisition(P = 0.01). A multivariable conditional logistic regression model (that excluded ATP
pass rate) found that only colonization pressure was associated with acquisition of
MRSA colonization.
Conclusions
In an outbreak setting, MRSA colonization pressure is significantly associated with
MRSA acquisition in the NICU independent of length of stay and gestational age.
Key Words
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Article Info
Publication History
Published online: April 30, 2021
Footnotes
Conflicts of interest: Drs. Balamohan, Beachy and Rubin and Nina Kohn do not have any conflicts of interest.
Funding : None.
Identification
Copyright
© 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
