MRSA hits neonatal units; hand hygiene cited.(Clinical Rounds)

Outbreaks of community-associated methicillin-resistant Staphylococcus aureus among healthy, term newborns in Chicago and Los Angeles County hospitals probably originated in the newborn nursery and illustrate the critical importance of consistent hand hygiene, the Centers for Disease Control and Prevention reported.

The CDC helped local health departments in both locations conduct independent investigations into the outbreaks, both of which occurred in 2004. In both outbreaks, the MRSA was a community-acquired rather than a health care-acquired strain. The Chicago hospital had a cluster of MRSA infections that led authorities to discover 11 cases, of which 9 (82%) were in infants delivered by cesarean section (MMWR 2006;55:329-32). Nine of the infants were male.

Symptoms were pustules, vesicles, and/or blisters on areas including the neck, groin, perineum, ears, and legs; most patients had lesions on more than one site. Median age at symptom onset was 7 days, and symptom onset occurred a median of 5 days post discharge from the newborn nursery. The infants were treated with topical antimicrobials in 10 cases, and 3 of those were treated with concomitant oral antimicrobials. One was hospitalized. All 11 infants recovered without incident, the CDC reported.

A subsequent investigation found that one physician and one nurse had nasal MRSA colonization. Both were restricted from work and required to undergo a course of intranasal mupirocin and to then test negative for MRSA.

In the Los Angeles County hospital, 11 cases of infection were discovered in two clusters. All were male newborns, and 7 of the 11 (64%) were delivered via C-section. All the infants had pustular/vesicular lesions in the groin area occurring a median of 3 days after nursery discharge. The median postdelivery stay was 4 days, as in the Chicago cases.

In contrast to the Chicago outbreak, 8 of these 11 infants were hospitalized. They were treated with parenteral antimicrobials and recovered without incident. The remaining ...