CONTROL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS IN A NEONATAL INTENSIVE-CARE UNIT - USE OF INTENSIVE MICROBIOLOGIC SURVEILLANCE AND MUPIROCIN

OBJECTIVE: To describe the epidemiology and the interventions used to control two methicillin-resistant Staphylococcus aureus (MRSA) epidemi cs involving 46 infants with two fatalities in a neonatal intensive ca re unit (NICU). SETTING: A 50-bed, level III NICU in a university hosp ital. INTERVENTIONS: After traditional interventions failed to stop th e first epidemic, an intensive microbiologic surveillance (IMS) progra m was developed. Cultures were obtained on all infants each week, and those colonized with MRSA were isolated. When an infant was found to b e colonized with MRSA, cultures immediately were obtained on all surro unding infants. This was continued until no MRSA-colonized infants wer e found in the area. During the first epidemic, mupirocin was used in an attempt to eradicate the organism from the unit. RESULTS: All infan ts, colonized and noncolonized, and parents of and personnel working w ith colonized infants were treated simultaneously with 5 days of mupir ocin. This failed to eradicate MRSA in colonized infants. The spread o f MRSA ceased in the unit, but a second epidemic occurred 4 months lat er. This time, IMS alone was successful in quickly containing the epid emic, and MRSA disappeared from the unit after all colonized infants w ere discharged. Plasmid analysis demonstrated that the same strain was responsible for both outbreaks. CONCLUSIONS: IMS and isolation are ef fective in containing the spread of MRSA in an NICU. The use of mupiro cin failed to eradicate the organism.