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MRSA colonization in neonates increased risk for hospital infection
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There is an increased risk for MRSA infection during hospitalization if patients are colonized with MRSA on admission, according to recent study findings published in Pediatrics.
“The development and implementation of molecular diagnostic methods, strict compliance with infection control policies, and establishment of decolonization policies with favorable results among pediatric patients seem to be the necessary next steps in this effort,” the researchers wrote.
Fainareti N. Zervou, MD, and colleagues from the infectious diseases division at Rhode Island Hospital and Warren Alpert Medical School of Brown University, both in Providence, R.I., conducted a meta-analysis to determine the burden of colonization on admission, the time trends and the significance of colonization. The researchers evaluated 18 studies published from 2006 to 2013 that reported the prevalence of MRSA colonization on ICU admission. Screening data was provided on 19,722 neonatal and pediatric patients.
There was a prevalence rate of 1.9% of MRSA colonization on admission to the neonatal ICU and pediatric ICU.
Eleven studies took place in North America, followed by five from Asia and two from Europe. The MRSA colonization rate was 2.3% in the US studies compared with 1.3% in the Asian studies (P=.18).
There was a 1.5% prevalence of MRSA colonization on admission among neonatal ICU patients compared with a 3% prevalence among pediatric ICU patients (P=.05).
Outborn neonates had a MRSA colonization prevalence of 5.8% compared with 0.2% among inborn neonates (P=.01). There was a MRSA colonization rate of 1.7% when only the nares were sampled compared with 1.4% from other screening policies (P=.72). Regarding culture methods, there was a prevalence rate of 2.2% using PCR only compared with 1.9% detected by other culture methods (P=.80).
During the ICU stay, among both pediatric and neonatal patients, there was an acquisition rate of 4.1% compared with 6.1% among neonates alone. Neonates colonized with MRSA had a 24.2 times increased risk for developing a MRSA infection compared with noncolonized neonates.
“The acquisition rate of MRSA colonization during neonatal ICU and pediatric ICU stay is disproportionately high, and the 29-fold higher colonization rate of outborn compared with inborn neonates highlights the need of early detection of MRSA colonization among interhospital transfer,” the researchers wrote. “Also, the 24.2 relative risk of subsequent infection among MRSA carriers, compared with noncarriers, underscores the importance of reducing the acquisition rate in the neonatal ICU and pediatric ICU.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Shahnawaz Amdani, MD
This meta-analysis gives a very good insight into the current load of MRSA colonization in our neonatal ICUs and pediatric ICUs. The studies included are up to the year 2013 giving us the latest update of the disease burden. Also, the majority of studies included in the meta-analysis (11/18 studies) are from North America, which gives us a good estimate of MRSA colonization rates nationwide. The pooled prevalence of MRSA colonization in North America is 2.3%, with prevalence being 1.5% in the neonatal ICU and 3% in the pediatric ICU. It is worth noting that three studies that did a sub-analysis revealed that MRSA colonization is higher in out born neonates (5.8%) vs. inborn neonates (0.2%). This difference might be partly explained by the fact that out born neonates might be in contact with health care system for longer time making them more likely to have acquired MRSA from health care setting. Although less likely, the other explanation might be less stringent practices at community or other healthcare settings where the babies might be before being transferred to the neonatal ICU. Hence, out born babies, should be isolated till their MRSA colonization status is known.
In the pediatric ICU studies – MRSA screening was done from nares, whereas from neonatal ICU MRSA screening was more commonly done from extra nasal sites (umbilicus, axillae, groin, throat, rectum). However, the most sensitive site for screening for MRSA colonization in the neonatal ICU and pediatric ICU remains nares.
One of the major points to take from the meta- analysis is the acquisition rate of MRSA during the neonatal ICU/pediatric ICU stay (4.1%). The relative risk for MRSA infections among patients who were colonized with MRSA on admission was 24.2 compared with those who were not colonized. This high number is quite alarming.
It is worth mentioning that based on the meta-analysis there is no statistically significant reduction in the colonization rates if decontamination practices are followed in the ICU. I personally strongly feel that strict isolation practice coupled with decontamination in the ICUs can decrease MRSA colonization rates and hence the rates of invasive MRSA infections in this vulnerable population.
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