Journal List > Korean J Perinatol > v.26(3) > 1013751

Lee, Cho, Yu, and Oh: Clinical Consideration of Surveillance Cultures for Out-born Neonates Transferred to Neonatal Intensive Care Unit

Abstract

Purpose

To identify trends in bacterial organisms and antimicrobial susceptibilities for transmission by outborn neonates, it is important to perform surveillance cultures. The aim of this study was to investigate major organisms and any other clinical factors through surveillance cultures of out-born neonates who transferred to neonatal intensive care units (NICU).

Methods

This study is a retrospective collected data among 189 out-born neonates admitted to NICU from Mar. 2012, to Feb. 2014. Surveillance cultures were obtained routinely from both nasal and axillary region and inoculated CHROM agar™ MRSA immediately. Bacterial culture identification and antibiotic susceptibility were carried out using Vitek II ID-GPI card.

Results

The most prevalent organisms isolated from the nasal surveillance cultures were methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative Staphylococcus (CoNS) (each 17 cases vs. 11 cases); both vancomycin and rifampin were susceptible. Only 1 case of S. epidermidis has same result in blood and surveillance culture. Demographic, clinical and healthcare related parameters according to surveillance culture results were compared, but no obvious association was apparent on above parameters. Nevertheless, positive surveillance culture group showed lower birth weight and longer duration until transferred to NICU.

Conclusion

In our surveillance culture study showed that MRSA and CoNS were the most common organisms in out-born neonates; both were penicillin- and oxacillin-resistant on antibiotic susceptibility testing. Although there is no statistical meaning, positive surveillance culture group showed relatively lower birth weight and longer duration from birth to NICU arrival. These findings were contributed to obtain a reliable policy of the transmission in NICU.

References

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Fig. 1.
Regional distribution of local clinics which transferred neonates.
kjp-26-183f1.tif
Fig. 2.
Antibiotics sensitivity result of surveillance culture organisms (MRSA, CoNS). Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; CoNS, Coagulase negative Staphylococcus; TMP/SMX, Trimethoprim-sulphamethoxazole; S, sensitivity; I, intermediate; R, resistance.
kjp-26-183f2.tif
Table 1.
Clinical Results According to Variables in Surveillance Culture
Variables Number
Number of positive culture neonates 40/189 (21.2%)
Number of positive culture cases
Total 44/378 (11.6%)
Culture sites
Nares 33/189 (17.5%)
Axilla 11/189 (5.8%)
Number of MRSA culture cases
Total 24/44 (54.6%)
Transferred from
Clinics 22/24 (91.7%)
Homes 2/24 (8.3%)

Four cases were cultured on both sites Abbreviation: MRSA, Methicillin-resistant Staphylococcus aureus.

Table 2.
Organisms from Surveillance Cultures
Organism Nares (n=33) Axilla (n=11) Total (n=44)
Staphylococcus aureus 3 (9.1%)   3 (6.8%)
MRSA 17 (51.5%) 7 (63.6%) 24 (54.6%)
Coagulase negative species 11 (33.3%) 3 (27.3%) 14 (31.8%)
Coagulase negative Staphylococcus 7 1  
Staphylococcus epidermidis 3 1  
Staphylococcus hemolyticus 1    
Staphylococcus hominis   1  
Others 2 (6.1%) 1 (9.1%) 3 (6.8%)
Lactococcus gravieae 1    
Enterococcus faecalis 1    
Escherichia coli   1  

Four cases were cultured on both sites Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus

Table 3.
Comparison of Perinatal Characteristics according to Surveillance Culture Results
  Culture Positive (n=40) Culture Negative (n=149) P-value
Male 22 (55%) 88 (59%) 0.401
Cesarean section delivery 17 (42.5%) 70 (47.0%) 0.614
Gestational age (week) 38.49±1.96 38.19±1.70 0.636
Birth weight (g) 2,970±410 3,030±550 0.074
1 minute Apgar score 8.35±0.94 8.15±1.38 0.271
5 minute Apgar score 9.52±0.78 9.18±1.22 0.171
At admission
WBC (x103/µL) 17.0±6.18 17.0±9.02 0.976
Neutrophil (%) 67.03±14.87 64.39±14.08 0.784
Lymphocyte (%) 21.93±8.47 27.16±26.69 0.270
Hb. (g/dL) 16.11±2.68 16.58±2.50 0.997
PLT (x103/µL) 253.67±60.42 247.51±63.52 0.727
CRP (mg/L) 3.86±9.07 3.62±10.09 0.751
Transferred from clinics 37 (92.5%) 137 (91.9%) 0.908
Transferred with physicians 29 (72.5%) 105 (70.5%) 0.802
Between birth and admission (hr) 38.45±34.36 20.50±31.57 0.164

Abbreviations: WBC, white blood cell; Hb, Hemoglobin; PLT, platelet; CRP, C-reactive protein

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