Methicillin-Resistant and Susceptible Staphylococcus aureus Bacteremia and Meningitis in Preterm Infants

• Authors: Andi L Shane, Emory University; Nellie I. Hansen, RTI International; Barbara J Stoll, Emory University; Edward F. Bell, University of Iowa; Pablo J. Sanchez, University of Texas Southwestern; Seetha Shankaran, Wayne State University; Abbot R. Laptook, Brown University; Abhik Das, RTI International; Michele C. Walsh, Case Western Reserve University; Ellen C. Hale, Emory University; Nancy S. Newman, Case Western Reserve University; Stephanie J. Schrag, Centers for Disease Control and Prevention; Rosemary D. Higgins, National Institutes of Health
• Journal Title: Pediatrics
• Volume: Volume 129, Number 4
• Publisher: American Academy of Pediatrics | 2012-04, Pages e914-e922
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1542/peds.2011-0966
• Subjects: Health Sciences, Epidemiology
• Keywords: Staphylococcus aureus; methicillin resistant; infant; newborn

Abstract

BACKGROUND: Data are limited on the impact of methicillin-resistant Staphylococcus aureus (MRSA) on morbidity and mortality among very low birth weight (VLBW) infants with S aureus (SA) bacteremia and/or meningitis (B/M). METHODS: Neonatal data for VLBW infants (birth weight 401–1500 g) born January 1, 2006, to December 31, 2008, who received care at centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were collected prospectively. Early-onset (≤72 hours after birth) and late-onset (>72 hours) infections were defined by blood or cerebrospinal fluid cultures and antibiotic treatment of ≥5 days (or death <5 days with intent to treat). Outcomes were compared for infants with MRSA versus methicillin-susceptible S aureus (MSSA) B/M. RESULTS: Of 8444 infants who survived >3 days, 316 (3.7%) had SA B/M. Eighty-eight had MRSA (1% of all infants, 28% of infants with SA); 228 had MSSA (2.7% of all infants, 72% of infants with SA). No infant had both MRSA and MSSA B/M. Ninety-nine percent of MRSA infections were late-onset. The percent of infants with MRSA varied by center (P < .001) with 9 of 20 centers reporting no cases. Need for mechanical ventilation, diagnosis of respiratory distress syndrome, necrotizing enterocolitis, and other morbidities did not differ between infants with MRSA and MSSA. Mortality was high with both MRSA (23 of 88, 26%) and MSSA (55 of 228, 24%). CONCLUSIONS: Few VLBW infants had SA B/M. The 1% with MRSA had morbidity and mortality rates similar to infants with MSSA. Practices should provide equal focus on prevention and management of both MRSA and MSSA infections among VLBW infants.