MRSA infection in neonatal intensive care units

Methicillin-resistant S. aureus strains increased in the U.S. from 2.4% in 1975 to 29% in 1991. Once established, MRSA is very difficult to eradicate. One of the biggest challenges is blocking cross-transmission of these organisms. legitimate patients are more prone to contagious disease and colonization by MRSA, and neonates in NICUs are a high-risk group (Finkelstein, 1999, 24).Risk factors for acquiring MRSA entangle prolonged hospitalization a stay in an ICU or burn unit previous antimicrobial therapy surgical site transmissions and vulnerability to colonized or infected patients. The majority of MRSA infections in neonates are master(a) bacteremias and pneumonias. MRSA infections shed also been associated with increased morbidity and mortality, and greater hospital cost than those due to methicillin-sensitive Staphylococcus aureus (MSSA).Why are neonates more prone to MRSA infection?With regards to disrobe infection it has been shown that an infants gestational maturat e has a great trespass on cutaneal parapet function as measured by transepidermal water loss. Preterm infants younger than 28 weeks show decreased functioning of the epidermal barrier, placing them at risk for cutaneous bacterial infection (Kalia, 1998, 323). The skin barrier attains full function, similar to adult skin, by 2 to 4 weeks of age but can take as long as 8 weeks in extremely premature infants. Mandel et al. (2004, 161) conducted a retrospective analysis of the affair of cutaneous abscess in sepsis. They erect that in 22% of the newborn infants with nosocomial sepsis, cutaneous abscess was the underlying caexercising.Additionally, their immune systems are underdeveloped, with white blood cells-neutrophils in particular-moving more slowly than adults. Its suspected that neonates become colonized with S. aureus soon afterward being placed in a nursery, with the umbilical stump as the site of initial colonization. Factors identified with MRSA extravasations in NICUs allow in high infant-to-staff ratios and infection transmission through hand behavior by health tutorship workers (AAP, 1997)Spread of MRSA transmittal and preventionMRSA is found on the anterior nares, groin, and perineum, S. aureus is a normal part of the ashes flora. Its also a common pathogen, do major infections in both compromised and uncompromised patients. The normal immune response of the body can overcome any MRSA attempt to infection, but in the intense awe due to reduced immune response, and bacterial resistance, these organisms van fabricate havoc. In a report from Australia quoted by Park (2007, 26-27), it was shown that from 1992 to 1994, methicillin-resistant S. aureus (MRSA) infections ca expenditured only 8% of staphylococcal infections but from 1995 to 1998, there was an disclosebreak of MRSA infection in 2 Melbourne hospitals.Methods to halt the circulate of MRSA outbreaks include reducing overcrowding and improving staffing patterns, treating umbilica l pile with triple-dye, and bathing full-term infants with hexachlorophene. But unless strict adherence to infection retain is maintained, it is not possible to control this infection. Handwashing is close important. The American Academy of pedology recommends that neonatal nursery staff perform a three-minute handwash at the start of each shift, cleansing up to the elbows with an antiseptic soap and sponger brush (AAP, 1997).Infected neonates should be placed on contact precautions. hither the infant must be handled with gloves, and if possible, appearing on the spacing available and the corking status of the infant, they should be assigned to isolated chambers (Larson, 1995, 259, 262). Hitomi etal (2000, 127), advocate the use of mupirocin as a nasal spray to control nasal carriage of MRSA in the hospital staff, which act as the greatest source of spread of this infection.Effects of nosocomial MRSA infectionAccording to the NNIS (2002), In 2000, 55.3% of S. aureus isolates causing nosocomial infections among patients hospitalized in intensive care units in hospitals reporting to the depicted object Nosocomial Infection Surveillance System were resistant to methicillin. Nambiar etal(2003, 224) give an interesting identify of the complications MRSA can cause in an intensive care setting. They describe an outbreak of MRSA, in which neonates had meningitis, blood stream infection (with its complications soft tissue abscess, injure and a right atrial thrombus, suppurative thrombophlebitis, osteoarthritis of the distal femoris and knee joint). Masanga (1999, 169) reported colonic stenosis after MRSA enterocolitis.The predisposing factors for neonatal MSSA enterocolitis include breast nutriment from a pay off with staphylococcal mastitis,an indwelling feeding catheter and malnutrition. The clinical picture of MSSA enterocolitis in the neonate is characterized by acute aggression of diarrhea and ileus.Necrotizing enterocolitis. intensive care includin g mechanical ventilation, indwelling feeding catheter, the use of antibiotics, the delay of feeding causing the lower acidity of gastric contents, inactive peristalsis and the change of bowel flora, conditions similar to those seen in postoperative patients most likely predisposed to abnormal MRSA growth and resultant enterocolitis. toxic blow out of the water syndrome (combination of erythema and thrombocytopenia, low-positive C-reactive protein (CRP) value, or fever), (Richtmann etal, 2000, 88-89, Takahashi, 2003, 234-35).Effect on parentsThe illness in the neonate is a great source of stress to the parents. Not only is the child disjunct from the mother, which leads to anxiety for the mother, and nursing problems. There occur problems of lactation, with breast engorgement and galactorrhoea. In addition, the mother is at a greater risk of catching infection from a septicemic child with pneumonia and exanthemas. Skin infection can spread via contact. so parents are at an increa sed risk from a child bear upon with MRSA infection.TreatmentPrevention is the best intercession. This infection can be chop-chop fatal in the neonates, particularly the preterm infants. Prompt recognition of the symptoms and active measures to prevent spread can reduce the morbidity and mortality. Cultures should be obtained for susceptibility endeavor in any child with a presumed S. aureus infection that is moderate to severe. The survival of empiric therapy, before susceptibility testing, and the choice of definitive therapy will depend on the local antibiotic resistance patterns, the tissue site and unkindness of infection, and the toxicity profile of the antibiotic.Vancomycin has been the traditional antibiotic employed for the treatment of MRSA pneumonia. It has been found, however, that problems with lung tissue penetration may limit the effectiveness of vancomycin Similarly, daptomycin has been shown to have limited activity for pneumonia due to limited lung penetratio n and inhibition by surfactant. Linezolid has also recently been evaluated as a specific treatment for MRSA pneumonia, and found to have good lung tissue penetration capability (Bradley, 200575-77)ConclusionsMRSA infection in the neonatal intensive care setting is associated with exceptional morbidity and mortality. handicap measures are the key to victory against MRSA. Each unit has to chart out effective protocols of infection control and adhere to it with a strong will.References1 Finkelstein LE etal(1999MRSA in NeonatesAm J Nurs, tawdriness 99(1).January.242 Kalia YN, Nonato LB, Lund CH, et al(1998) Development of skin barrier function in premature infants. J Invest Dermatol 111320-3263 Mandel D, Littner Y, Mimouni FB, et al.( 2004) Nosocomial cutaneous abscesses in septic infants. Arch Dis Child fetal Neonatal Ed 89F161-F1624 American Academy of Pedaitrics and American College of Obstetricians and Gynecologists (1997)Guidelines for Perinatal care, 4th ed. Elk Grove Village, I L, The Academy,5 PARK CH etal(2007). changing trend of neonatal infection Experience at a fresh established regional medical center in KoreaPediatr Int, hatful 49(1).24306 Larson, E. L(1995). APIC guideline for handwashing and hand antisepsis in health care settings. Am.J. Infect.Control 23251-269.7 Hitomi S, Kubota M, Mori N, et al(2005) Control of methicillin resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by undiscriminating use of nasal mupirocin ointment. J Hosp Infect 46 1231298 National Nosocomial Infections Surveillance (NNIS) System Report. Data Summary from January 1992 to June 2001. Issued August 2001. operational at http//www.cdc.gov/ncidod/hip/NNIS/members/members.htm nnisreports. Accessed Mar 5 20079 Nambiar S, Herwaldt LA, Singh N (2003). clap of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med, Volume 4(2).220-22610 Masanga K et al (1999). Colonic Stenosis After Severe Methicillin-Resistant Staphylococcus Aureus Enterocolitis In A Newborn. Pediatr Infect Dis J, Volume 18(2).169-17111 Richtmann R etal.(2000) Outbreak Of Methicillin-Resistent Staphylococcus Aureus (Mrsa) Infection On A Neonate Intensive Care Unit (Nicu) The lynchpin Role Of Infection Control Measures. Am J Infect Control, Volume 28(1).February 88-89.12 Takahashi N (2003). Neonatal toxic shock syndrome-like exanthematous disease (NTED). Pediatr Int, Volume 45(2).23323713 Bradley JS (2005). Newer antistaphylococcal agents Curr Opin Pediatr, Volume 17(1).71-77