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NHSN Annual Update:
Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections

Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007

Antimicrobial-resistant pathogens that cause healthcare-associated infections (HAIs) pose an ongoing and increasing challenge to hospitals, both in the clinical treatment of patients and in the prevention of the cross-transmission of these problematic pathogens.  Describing the magnitude of the problem with respect to these antimicrobial-resistant pathogens is challenging, because the levels of antimicrobial resistance vary for different types of healthcare facilities and for different geographic areas, and some resistance phenotypes are difficult for laboratories to detect. However, the findings from such attempts may help the infection control and public health communities target problems and utilize resources more efficiently.

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Featured in The Times
"Ireland 'losing war' on superbug" February 15, 2009
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The research, published in Infection Control and Hospital Epidemiology, found one third of hospitals did not have a written policy on antibiotic use, and only 35% had an antibiotic stewardship programme.

February 2006

Volume 27, Number 2
Infect Control Hosp Epidemiol 2006;27:139–145
© 2006 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2006/2702-0006$15.00
DOI: 10.1086/501216
ORIGINAL ARTICLE

Management of Outbreaks of Methicillin‐Resistant Staphylococcus aureus Infection in the Neonatal Intensive Care Unit: A Consensus Statement

Susan I. Gerber, MD;

Roderick C. Jones, MPH;

Mary V. Scott, MPH;

Joel S. Price, MS;

Mark S. Dworkin, MD, MPHTM;

Mala B. Filippell, RN, BSN, CIC;

Terri Rearick, RN, BS, CIC;

Stacy L. Pur, RN, BSN;

James B. McAuley, MD, MPH;

Mary Alice Lavin, RN, MJ, CIC;

Sharon F. Welbel, MD;

Sylvia Garcia‐Houchins, CIC;

Judith L. Bova, BS;

Stephen G. Weber, MD, MSc;

Paul M. Arnow, MD;

Janet A. Englund, MD;

Patrick J. Gavin, MD;

Adrienne G. Fisher, MT;

Richard B. Thomson, PhD;

Thomas Vescio, MD;

Teresa Chou, MPH;

Daniel C. Johnson, MD;

Mary Beth Fry, BS, CIC;

Anne H. Molloy, MSN, CIC;

Laura Bardowski, RN;

Gary A. Noskin, MD

Dr. Gerber and Mr. Jones are from the Chicago Department of Public Health, Chicago; Mr. Price and Dr. Dworkin are from the Illinois Department of Public Health, Chicago; Ms. Filippell and Ms. Rearick are from Children’s Memorial Hospital, Chicago; Ms. Pur and Dr. McAuley are from Rush University Medical Center, Chicago; Ms. Lavin and Dr. Welbel are from John H. Stroger, Jr. Hospital of Cook County, Chicago; Ms. Garcia‐Houchins, Ms. Bova, Dr. Weber, Dr. Arnow, and Dr. Englund are from the University of Chicago Hospitals, Chicago (Dr. Arnow was at this institution at the time the work was done but is now deceased). Ms. Chou is from Advocate Illinois Masonic Medical Center, Chicago; Dr. Johnson is from Mount Sinai Hospital, Chicago; Ms. Fry and Ms. Molloy are from the University of Illinois Medical Center, Chicago; and Ms. Bardowski and Dr. Noskin are from Northwestern Memorial Hospital, Chicago, Illinois. Ms. Scott is from the Evanston Department of Health and Human Services, Evanston, and Dr. Gavin, Ms. Fisher, Dr. Thomson, and Dr. Vescio are from Evanston Northwestern Healthcare, Evanston, Illinois. (Present affiliations: Ms. Scott is now at the Illinois Department of Public Health, Chicago, Illinois, and Dr. Englund is now at the University of Washington/Children's Hospital and Regional Medical Center, Seattle, Washington.)

Objective.In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago‐Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin‐resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.

Design.Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.

Setting.Level III NICUs at Chicago‐area hospitals.

Participants.Neonates and healthcare workers associated with the level III NICUs.

Methods.From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.

Results.Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA‐positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.

Conclusion.The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.

Received April 18, 2005; accepted August 18, 2005; electronically published February 8, 2006.

Address reprint requests to Susan I. Gerber, MD, Chicago Department of Public Health, 2160 W. Ogden Ave., Chicago, IL 60612 ().

Cited by

Fernanda C. Lessa, Jonathan R. Edwards, Scott K. Fridkin, Fred C. Tenover, Teresa C. Horan, Rachel J. Gorwitz. (2009) Trends in Incidence of Late-Onset Methicillin-Resistant Staphylococcus aureus Infection in Neonatal Intensive Care Units. The Pediatric Infectious Disease Journal 28:7, 577-581
Online publication date: 1-Aug-2009.
CrossRef
Ryan M. McAdams, Michael W. Ellis, Sherry Trevino, Michael Rajnik. (2009) Spread of methicillin-resistant Staphylococcus aureus USA300 in a neonatal intensive care unit. Pediatrics International 50:6, 810-815
Online publication date: 1-Jan-2009.
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Walter Zingg, Klara M Posfay-Barbe, Didier Pittet. (2008) Healthcare-associated infections in neonates. Current Opinion in Infectious Diseases 21:3, 228-234
Online publication date: 1-Jul-2008.
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M. Rathore. (2008) Mother-to-child Transmission of MRSA Unlikely Cause of Neonatal Infection. AAP Grand Rounds 19:5, 58-58
Online publication date: 1-Jun-2008.
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W Charles Huskins. (2007) Interventions to prevent transmission of antimicrobial-resistant bacteria in the intensive care unit. Current Opinion in Critical Care 13:5, 572-577
Online publication date: 1-Nov-2007.
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(2007) Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 50:10, 1265-1303
Online publication date: 1-Nov-2007.
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Jay R. McDonald, Charlene M. Carriker, Brian C. Pien, Jane V. Trinh, John J. Engemann, Lizzie J. Harrell, Mary A. Oden, David T. Tanaka, Ronald N. Goldberg, Daniel J. Sexton, Keith S. Kaye. (2007) Methicillin-Resistant Staphylococcus aureus Outbreak in an Intensive Care Nursery: Potential for Interinstitutional Spread. The Pediatric Infectious Disease Journal 26:8, 678-683
Online publication date: 1-Sep-2007.
CrossRef
Stephen G. Weber, MD, MS; Susan S. Huang, MD, MPH; Shannon Oriola, RN, CIC, COHN; W. Charles Huskins, MD, MSc; Gary A. Noskin, MD; Kathleen Harriman, PhD, MPH, RN; Russell N. Olmsted, MPH, CIC; Marc Bonten, MD, PhD; Tammy Lundstrom, MD, JD; Michael W. Climo, MD; Mary‐Claire Roghmann, MD, MS; Cathryn L. Murphy, MPH, PhD, CIC; Tobi B. Karchmer, MD, MS. (2007) Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin‐Resistant Staphylococcus aureus and Vancomycin‐Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force •. Infection Control and Hospital Epidemiology 28:3, 249-260
Online publication date: 1-Mar-2007.
Abstract-Full Text-PDF Version (203 kB)
Barry M. Farr, MD, MSc. (2006) What To Think If the Results of the National Institutes of Health Randomized Trial of Methicillin‐Resistant Staphylococcus aureus and Vancomycin‐Resistant Enterococcus Control Measures Are Negative (and Other Advice to Young Epidemiologists): A Review and an Au Revoir •. Infection Control and Hospital Epidemiology 27:10, 1096-1106
Online publication date: 1-Oct-2006.
Abstract-Full Text-PDF Version (214 kB)
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