Risk Factors for Nosocomial Methicillin Resistant Staphylococcus aureus (MRSA) Colonization in a Neonatal Intensive Care Unit: A Case-Control Study
Abstract
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,…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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