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Successful management of an MRSA outbreak in a neonatal intensive care unit

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Abstract

We report an MRSA outbreak in our 25-bed tertiary neonatal intensive care unit (NICU), which was successfully contained. Methods include a retrospective review of patient files, microbiology records and meeting protocols. During the seven months of outbreak, 27 patients and seven health care workers (HCWs) had positive cultures for MRSA. The outbreak was caused by the epidemic Rhine-Hessen strain; cultured isolates were monoclonal. After a sharp increase of the number of new MRSA-cases the installation of an outbreak management team (OMT) and implementation of comprehensive measures (extensive screening and decolonization strategy including orally applied vancomycin, isolation wards, intensive disinfection regimen) successfully terminated the outbreak within one month. Ten (53%) of 19 patients with completed follow-up and all of the HCWs were decolonized successfully. Gastrointestinal colonization was present in 15 of 27 (56%) neonates, and was associated with poor decolonization success (30% vs. 78% in absence of gastrointestinal colonization). A comprehensive outbreak management can terminate an outbreak in a NICU setting within a short time. Thorough screening of nares, throat and especially stool is necessary for correct cohorting. Gastrointestinal decolonization in neonates seems difficult.

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Acknowledgement

The authors thank the nursing staff of the Department of Neonatology, the company medical officer, and the clinical staff of the Department of Hospital Hygiene for their contribution to control this outbreak.

Financial support

No financial support was provided for this study.

Potential conflict of interest

All authors report no conflicts of interest.

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Authors and Affiliations

  1. Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany

    N. Heinrich

  2. Children’s Hospital Medical Center, Department of Neonatology, University of Bonn, Bonn, Germany

    N. Heinrich, A. Mueller & P. Bartmann

  3. Department for Paediatric Hematology and Oncology, Saarland University Hospital, Homburg, Germany

    A. Simon

  4. Institute of Medical Microbiology, Immunology, and Parasitology, University of Bonn, Bonn, Germany

    G. Bierbaum

  5. Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany

    S. Engelhart

Authors
  1. N. Heinrich
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  2. A. Mueller
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  3. P. Bartmann
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  4. A. Simon
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  5. G. Bierbaum
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  6. S. Engelhart
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Corresponding author

Correspondence to N. Heinrich.

Additional information

Both Norbert Heinrich and Andreas Mueller contributed equally.

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Heinrich, N., Mueller, A., Bartmann, P. et al. Successful management of an MRSA outbreak in a neonatal intensive care unit. Eur J Clin Microbiol Infect Dis 30, 909–913 (2011). https://doi.org/10.1007/s10096-011-1175-4

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  • DOI: https://doi.org/10.1007/s10096-011-1175-4

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