- BLR: beta-lactamase-resistant
- CA-MRSA: community-acquired methicillin-resistant Staphylococcus aureus
- CLSI: Clinical Laboratory Standards Institute
- MRSA: methicillin-resistant Staphylococcus aureus
- NICU: neonatal intensive care unit
- NTED: neonatal toxic shock-like exanthematous disease
- PFGE: pulsed-field gel electrophoresis
- PVL: Panton-Valentine leukocidin
- TSST-I: toxic shock syndrome toxin type I
After completing this article, readers should be able to:
Describe the clinical manifestations of methicillin-resistant Staphylococcus aureus (MRSA) infections in neonates.
Delineate the role of community-acquired strains of MRSA in the development of sepsis in neonatal intensive care units (NICUs).
Describe the route of transmission of MRSA.
List the measures necessary to control MRSA in NICUs.
Staphylococcus aureus has been recognized as a common nosocomial pathogen in nurseries since devastating outbreaks caused serious infections in the 1950s. Adults are commonly colonized, typically involving the nose and skin, with reported rates of carriage ranging from 30% to 50%. Skin colonization with S aureus can occur within 24 to 48 hours of birth from contact with the skin of adults or the environment. S aureus colonization of newborns varies from 20% to 90% over the first week after birth, with the most common sites including the anterior nares, umbilicus, and skin (groin and axillae). The probability of staphylococcal colonization increases with prolonged duration of hospitalization. S aureus is the second most common pathogen causing late-onset sepsis in very low-birthweight infants in neonatal intensive care units (NICUs).
Since its emergence in the 1960s in the United States, methicillin-resistant S aureus (MRSA) has become a common health care-associated pathogen. According to 2001 data from the National Nosocomial Surveillance System, it comprises 55% of S aureus strains causing nosocomial infection. Traditional risk factors for MRSA colonization or infection have included contact with the health care system, such as recent hospitalization, surgery, close contact with hospitalized individuals, or prior antimicrobial treatment. Numerous outbreaks of MRSA in NICUs have been described, and MRSA has become a major, sometimes endemic, problem in many NICUs. As complex, prolonged care for infants at the extremes of gestational age and birthweight has become increasingly common, so too has the impact of …