Am J Perinatol 2003; 20(3): 125-136
DOI: 10.1055/s-2003-40010
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Staphylococcus aureus Outbreaks Among Newborns: New Frontiers in an Old Dilemma

Nevio Cimolai
  • Program of Microbiology, Virology, and Infection Control, Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Canada
Further Information

Publication History

Publication Date:
12 June 2003 (online)

ABSTRACT

The acquisition of Staphylococcus aureus by the newborn in the early neonatal period is common. Most such acquisitions are not followed by infection, although the potential for serious infection increases in the intensive care unit setting. Attack rates for infection are quite variable, but outbreaks have occurred on many occasions. Although some bacterial virulence factors, such as exfoliative toxins, are associated with outbreaks, most epidemic strains do not have well-defined virulence factors that can be incriminated. There are many possible control measures, but the implementation of these are balanced by the existing circumstances and perceived cost. As methicillin-resistant S. aureus (MRSA) becomes endemic in hospital settings, these bacteria are becoming much more common in nursery outbreaks. Over time, antibiotic selection and enhanced disease causation will lead to the evolution of hypervirulent MRSA clones. The latter will become an increasing problem unless effectively controlled.

REFERENCES

  • 1 Shaffer T E, Baldwin J N, Wheeler W E. Staphylococcal infections in nurseries.  Adv Pediatr . 1958;  10 243-281
  • 2 Colbeck J C. An extensive outbreak of staphylococcal infections in maternity units.  CMAJ . 1949;  61 557-568
  • 3 Grullon K E, Grimes D A. The safety of early postpartum discharge: a review and critique.  Obstet Gynecol . 1997;  90 860-865
  • 4 Cimolai N, Espersen F. Staphylococcal infections. In: Cimolai N, ed. Laboratory Diagnosis of Bacterial Infections New York: Marcel Dekker, Inc. 2001: 229-256
  • 5 Struelens M. Molecular epidemiology. In: Cimolai N, ed. Laboratory Diagnosis of Bacterial Infections New York: Marcel Dekker, Inc. 2001: 125-146
  • 6 Martyn G. Staphylococci in the newborn.  Br Med J . 1949;  1 710-713
  • 7 Forfar J O, Balf C L, Elias-Jones T F, Edmunds P N. Staphylococcal infection of the newborn.  Br Med J . 1953;  2 170-174
  • 8 Gillespie W A, Simpson K, Tozer R C. Staphylcoccal infection in a maternity hospital: epidemiology and control.  Lancet . 1958;  2 1075-1080
  • 9 Gooch J J, Britt E M. Staphylococcus aureus colonization and infection in newborn nursery patients.  Am J Dis Child . 1978;  132 893-896
  • 10 Baldwin J N, Rheins M S, Sylvester R F, Shaffer T E. Staphylococcal infections in newborn infants III: colonization of newborn infants by Staphylococcus pyogenes Am J Dis Child .  1957;  94 107-116
  • 11 Rountree P M, Barbour R GH. Staphylococcus pyogenes in newborn babies in a maternity hospital.  Med J Aust . 1950;  1 525-528
  • 12 Mitsuda T, Arai K, Fujita S, Yokota S. Epidemiological analysis of strains of methicillin-resistant Staphylcoccus aureus (MRSA) infection in the nursery: prognosis of MRSA carrier infants.  J Hosp Infect . 1995;  31 123-134
  • 13 Thompson D J, Gezon H M, Hatch T F, Rycheck R R, Rogers K D. Sex distribution of Staphylococcus aureus colonization and disease in newborn infants.  New Engl J Med . 1963;  269 337-341
  • 14 Dunkle D M, Naqui S H, McCallum R, Lofgren J P. Eradication of epidemic methicillin-resistant gentamicin-resistant Staphylococcus aureus in the intensive care nursery.  Am J Med . 1981;  70 455-458
  • 15 Jernigan J A, Titus M G, Groschel O HM, Getchell-White S I, Farr B M. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus Am J Epidemiol .  1996;  143 496-504
  • 16 Michel M F, Priem C C. Control at hospital level of infections by methicillin-resistant staphylococci in children.  J Hygiene . 1971;  69 453-460
  • 17 Graham D R, Correa-Villasenor A, Anderson R L, Vollman J H, Baine W B. Epidemic neonatal gentamicin-methicillin-resistant Staphylococcus aureus infections associated with non-specific topical use of gentamicin.  J Pediatr . 1980;  97 972-976
  • 18 Reboli A C, John J F, Levkoff A H. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit.  Am J Dis Child . 1989;  143 34-39
  • 19 Hayakawa T, Hayashidera T, Yoneda K, Kagawa S, Kusunoki T. Unexpectedly prolonged colonization of exfoliative toxin A-producing methicillin-resistant Staphylococcus aureus in infants [letter].  Eur J Pediatr . 1998;  157 781
  • 20 Rosenfeld C R, Laptook A R, Jeffery J. Limited effectiveness of triple dye in preventing colonization with methicillin-resistant Staphylococcus aureus in a special care nursery.  Pediatr Infect Dis J . 1990;  9 290-291
  • 21 Webster J, Faoagali J L. Endemic methicillin-resistant Staphylococcus aureus in a special care baby unit: a 2 year review.  J Pediatr Child Health . 1990;  26 160-163
  • 22 Rountree P M, Heseltine M, Rheuben J, Shearman R P. Control of staphylococcal infection of the newborn by the treatment of nasal carriers in the staff.  Med J Aust . 1956;  1 528-533
  • 23 Haley R W, Bregman D A. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit.  J Infect Dis . 1982;  145 875-885
  • 24 Parker M T, Kennedy J. The source of infection in pemphigus neonatorum.  J Hygiene . 1949;  47 213-219
  • 25 Hedberg K, Ristinen T L, Soler J T. et al . Outbreak of erythromycin-resistant staphylococcal conjunctivitis in a newborn nursery.  Pediatr Infect Dis J . 1990;  9 268-273
  • 26 Denton G D, Kalz G, Foley A R. An investigation of an outbreak of staphylococcus folliculitis (pemphigus neonatorum) by the use of bacteriophage typing of Staphylococcus pyogenes CMAJ .  1950;  62 219-228
  • 27 Allison V D, Hobbs B C. An inquiry into the epidemiology of pemphigus neonatorum.  Br Med J . 1947;  2 1-7
  • 28 Allen K D, Ridgway E J, Parsons L A. Hexachlorophene powder and neonatal staphylococcal infection.  J Hosp Infect . 1994;  27 29-33
  • 29 Hyams P J, Counts G W, Monkus E, Feldman R, Kicklighter J L, Gonzalez C. Staphylococcal bacteremia and hexachlorophene bathing.  Am J Dis Child . 1975;  129 595-599
  • 30 Najem G R, Riley H D, Ordway N K, Yoshioka H. Clinical and microbiologic surveillance of neonatal staphylococcal disease: relationship to hexachlorophene whole-body bathing.  Am J Dis Child . 1975;  129 297-302
  • 31 Hlady W G, Middaugh J P. An epidemic of bullous impetigo in a newborn nursery due to Staphylococcus aureus: epidemiology and control measures.  Alaska Med . 1986;  28 99-103
  • 32 Howells C HL, Jones H E. Two outbreaks of neonatal skin sepsis caused by Staphylococcus aureus, phage type 71.  Arch Dis Child . 1961;  36 214-216
  • 33 Wilcox M H, Fitzgerald P, Freeman J. et al . A five year outbreak of methicillin-susceptible Staphylococcus aureus phage type 53,85 in a regional neonatal unit.  Epidemiol Infect . 2000;  124 37-45
  • 34 Mackenzie A, Johnson W, Heyes B, Norrish B, Jamieson F. A prolonged outbreak of exfoliative toxin A-producing Staphylococcus aureus in a newborn nursery.  Diagn Microbiol Infect Dis . 1995;  21 69-75
  • 35 Nakashima A K, Allen J R, Martone W J, Plikaytis B D, Stover B, Cook L N, Wright S D. Epidemic bullous impetigo in a nursery due to a nasal carrier of Staphylococcus aureus: role of epidemiology and control measures.  Infect Control . 1984;  5 326-331
  • 36 Belani A, Sheretz R J, Sullivan M L, Russell B A, Reumen P D. Outbreak of staphylococcal infection in two hospital nurseries traced to a single nasal carrier.  Infect Control . 1986;  7 487-490
  • 37 Choudhary M NH, Kambal A M. An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit.  J Hosp Infect . 1992;  22 299-305
  • 38 Haddad Q, Sobayo E I, Basit O BA, Rotimi V O. Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit.  J Hosp Infect . 1993;  23 211-221
  • 39 Moore E P, Williams E W. A maternity hospital outbreak of methicillin-resistant Staphylococcus aureus J Hosp Infect .  1991;  19 5-16
  • 40 Richardson J F, Quoraishi A HM, Francis B J, Marples R R. Beta-lactamase negative, methicillin-resistant Staphylococcus aureus in a newborn nursery: report of an outbreak and laboratory investigations.  J Hosp Infect . 1990;  16 109-121
  • 41 Farrington M, Ling J, Ling T, French G L. Outbreak of infection with methicillin-resistant Staphylococcus aureus on neonatal and burn units of a new hospital.  Epidemiol Infect . 1990;  105 215-228
  • 42 Coovadin Y M, Bhana R H, Johnson A P, Haffejee I, Marples R R. A laboratory-confirmed outbreak of rifampin-methicillin-resistant Staphylococcus aureus (RMRSA) in a newborn nursery.  J Hosp Infect . 1989;  14 303-312
  • 43 Price E H, Brain A, Dickson J AS. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit.  J Hosp Infect . 1980;  1 221-228
  • 44 Hill V F, Ferguson D. Multiply-resistant Staphylococcus aureus (bacteriophage 90) in a special care baby unit.  J Hosp Infect . 1984;  5 56-62
  • 45 Gilbert G L, Asche V, Hewstone A S, Mathieson J L. Methicillin-resistant Staphylococcus aureus in neonatal nurseries.  Med J Aust . 1982;  1 455-459
  • 46 Mulhern B, Griffin E. An epidemic of gentamicin/ cloxacillin staphylococcal infection in a neonatal unit.  Ir Med J . 1987;  74 228-229
  • 47 Davies E A, Emmerson E A, Hogg G M, Patterson M F, Shields M D. An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control.  J Hosp Infect . 1987;  10 120-128
  • 48 Parks Y A, Noy M F, Aukett M A, Webb C A. Methicillin-resistant Staphylococcus aureus in milk.  Arch Dis Child . 1987;  62 82-84
  • 49 Haley R W, Cushion N B, Tenover F C. et al . Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit.  J Infect Dis . 1995;  171 614-624
  • 50 Zafar A B, Butler R C, Reese D J, Gaydos L A, Mennonna P A. Use of 0.3% triclosan (Bacti-Stat*) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery.  Am J Infect Control . 1995;  23 200-208
  • 51 Booth M C, Pence L M, Mahareshti P, Callegan M C, Gilmore M S. Clonal associations among Staphylococcus aureus isolates from various sites of infection.  Infect Immun . 2001;  69 345-352
  • 52 Moore P CL, Lindsay J A. Genetic variation among hospital isolates of methicillin-sensitive Staphylococcus aureus: evidence for horizontal transfer of virulence genes.  J Clin Microbiol . 2001;  39 2760-2767
  • 53 Cimolai N. Are all MRSA made equal?.  Can J Microbiol . 2002;  48 560-566
  • 54 Dowsett E G, Petts D N, Baker S L. et al . Analysis of an outbreak of staphylococcal scalded skin syndrome: strategies for typing “non-typeable” strains.  J Hosp Infect . 1984;  5 391-397
  • 55 Dave J, Reith S, Nash J Q, Marples R R, Dulake C. A double outbreak of exfoliative toxin-producing strains of Staphylococcus aureus in a maternity unit.  Epidemiol Infect . 1994;  112 103-114
  • 56 Pekkala D H, Low D E, Wyper P A. et al . The utility of restriction endonuclease analysis and phage typing in the epidemiologic investigation of a Staphylococcus aureus outbreak in a neonatal nursery.  Diagn Microbiol Infect Dis . 1992;  15 307-311
  • 57 Noel G J, Kreiswirth B N, Edelson P J. et al . Multiple methicillin-resistant Staphylococcus aureus strains as a cause for a single outbreak of severe disease in hospitalized neonates.  Pediatr Infect Dis J . 1992;  11 184-188
  • 58 Kaplan M H, Chmel H, Hsieh H C, Stephens A, Brinsko V. Importance of exfoliatin toxin A production by Staphylococcus aureus strains isolated from clustered epidemics of neonatal pustulosis.  J Clin Microbiol . 1986;  23 83-91
  • 59 Dancer S J, Simmons N A, Poston S M, Noble W C. Outbreak of staphylococcal scalded skin syndrome among neonates.  J Infect . 1988;  16 87-103
  • 60 Faden H S, Burke J P, Glasgow L A, Everett J R. Nursery outbreak of scalded-skin syndrome: scarlatiniform rash due to phage group I Staphylococcus aureus Am J Dis Child .  1976;  130 265-268
  • 61 Curran J P, Al-Salihi F L. Neonatal staphylococcal skin syndrome: massive outbreak due to an unusual phage type.  Pediatrics . 1980;  66 285-290
  • 62 McCartney J E, Yates T OR. Investigation of a staphylococcal epidemic in babies in a maternity hospital and similar outbreaks in other hospitals.  Med J Aust . 1956;  1 50-53
  • 63 Florman A L, Holzman R S. Nosocomial scalded skin syndrome.  Am J Dis Child . 1980;  134 1043-1045
  • 64 Saiman L, Jakob K, Holmes K W. et al . Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants.  Pediatr Infect Dis J . 1998;  17 329-334
  • 65 Rycheck R R, Taylor P M, Gezon H M. Epidemic staphylococcal pyoderma associated with Ritter's disease and the appearance of phage type 3B/71.  New Engl J Med . 1963;  269 332-337
  • 66 Dancer S J, Poston S M, East J, Simmons N A, Noble W C. An outbreak of pemphigus neonatorum.  J Infect . 1990;  20 73-82
  • 67 Light I J, Brackvogel V, Walton R L, Sutherland J M. An epidemic of bullous impetigo arising from a central admission-observation nursery.  Pediatrics . 1972;  49 15-21
  • 68 Albert S, Baldwin R, Czekajewski S, van Soestbergen A, Nachman R, Robertson A. Bullous impetigo due to group II Staphylococcus aureus: an epidemic in a normal newborn nursery.  Am J Dis Child . 1970;  120 10-13
  • 69 Isbister C, Durie E B, Rountree P M, Freeman B M. A further study of staphylococcal infection of the newborn.  Med J Aust . 1954;  2 897-900
  • 70 Keettel W C, Stoltz C R. An unusual epidemic of neonatal mastitis.  Am J Obstet Gynecol . 1950;  59 642-647
  • 71 Feldman F, Annunziata D. Staphylococcus aureus infections in the newborn infant.  J Pediatr . 1952;  41 399-402
  • 72 Webb J F. Newborn infections and breast abscesses of staphylococcal origin.  CMAJ . 1954;  70 382-388
  • 73 Rountree P M, Freeman B M. Infections caused by a particular phage type of Staphylococcus aureus Med J Aust .  1955;  2 157-161
  • 74 Douglas A, Knights H T. Some public health aspects of an outbreak of penicillin-resistant staphylococcal infection in a maternity hospital.  N Z Med J . 1956;  55 379-387
  • 75 Shaffer T E, Baldwin J N, Rheins M S, Sylvester R F. Staphylococcal infections in newborn infants I: study of an epidemic among infants and nursing mothers.  Pediatrics . 1956;  18 750-761
  • 76 Bressler R, Walson R D, Fulginiti V A. Hexachlorophene in the newborn nursery: a risk-benefit analysis and review.  Clin Pediatr . 1977;  16 342-351
  • 77 Jellard J. Umbilical cord as reservoir of infection in a maternity hospital.  Br Med J . 1957;  94 925-928
  • 78 Girou E, Pujada G, Legrand P, Cizeau F, Brun-Boisson C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high risk hospital areas with a high level of endemic MRSA.  Clin Infect Dis . 1998;  27 543-550
  • 79 Hitomi S, Kubota M, Mori N. et al . Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment.  J Hosp Infect . 2000;  46 123-129
  • 80 Clarke A JR, McGeoch A H, Sippe G R. Neonatal infection of the skin by Staphylococcus pyogenes Med J Aust .  1956;  1 655-658
  • 81 Light I J, Walton R L, Sutherland J M, Shinefield H R, Brackvogel V. Use of bacterial interference to control a staphylcoccal nursery outbreak.  Am J Dis Child . 1967;  113 291-300
  • 82 Perez Trallero E, Arenzana J G, Castaneda A A, Grisolia L P. Unusual multiresistant Staphylococcus aureus in a newborn nursery.  Am J Dis Child . 1981;  135 689-692
  • 83 Meguro H. MRSA infections in the neonatal unit.  Jpn J Clin Med . 1992;  50 1117-1121
  • 84 Aihara M, Sakai M, Iwasaki M. et al . Prevention and control of nosocomial infection caused by methicillin-resistant Staphylococcus aureus in a premature infant ward: preventive effect of a povidone-iodine wipe of neonatal skin.  Postgrad Med J . 1993;  69 (suppl 3) S117-S121
  • 85 Le Coq M, Simon I, Sire C. et al . Épidémie d'infections nosocomiales à Staphylococcus aureus résistant à la méticilline dans une maternité.  Pathol Biol . 2001;  49 16-22
  • 86 Tenover F C, Biddle J W, Lancaster M V. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus Emerg Infect Dis .  2001;  7 327-332