New guidelines issued for S aureus prevention, control in NICUs
The Centers for Disease Control and Prevention (CDC) has issued new recommendations for the prevention and control of Staphylococcus aureus in neonatal intensive care unit (NICU) patients.
The guidelines are based on current understanding of the transmission dynamics of S aureus in the NICU and were developed through a systematic review of the best available literature available through August 2019. The review was guided by questions about the most effective strategies for preventing S aureus transmission from colonized or infected NICU patients, which sampling sites and laboratory assays most effectively identify colonization in NICU patients, and what risk factors exist for S aureus infection in NICU patients.
The guidelines recommend performing active surveillance testing at regular intervals for S aureus colonization in NICU patients when there is increased evidence of infection or in an outbreak setting, and for methicillin-resistant S aureus colonization when there is evidence of ongoing healthcare-associated transmission. Active surveillance can be conducted using either culture-based or polymerase chain reaction detection methods, and samples should be collected from the nostrils. The authors conditionally recommend testing of infants from other newborn care units, and targeted decolonization for colonized NICU patients.
S aureus is the most common healthcare-associated pathogen in US NICUs, with an estimated incidence of up to 45 infections per 100,000 hospitalized infants, and rates of invasive S aureus infection are especially high in preterm and low birthweight infants. While infants may acquire the bacteria as part of their normal developing microbiota, those who are colonized with S aureus are at increased risk of infection.
A companion document from the Society for Healthcare Epidemiology of America (SHEA), published yesterday in Infection Control and Hospital Epidemiology, answers some of the questions that clinicians may have about S aureus detection and prevention in the NICU.
September CDC recommendations
Sep 14 SHEA white paper
US kids gaining ground on HPV vaccine coverage, but gaps remain
An analysis of 15 years' worth of US insurance data on human papillomavirus (HPV) vaccination in nearly 8 million girls and boys found increasing uptake, but that levels are still shy of targets with differences that vary by state. A team based at Harvard University published its findings yesterday in Pediatrics.
The investigators looked at HPV vaccination information from the MarketScan healthcare database from January 2003 to December 2017, examining one- and two-dose coverage by birth year, sex, and state. The team also examined associations between state vaccination policies and vaccine coverage. The study included 7,837,480 children.
For 15-year-old girls, one-dose coverage rose from 38% in 2011 to 57% in 2017, and over the same period, coverage in 15-year-old boys rose from 5% to 51%. For two doses over the same years, coverage increased from 30% to 46% in girls and from 2% to 39% in boys. As an example of differences in regional coverage, two-dose coverage in 2017 ranged from 80% for girls in Washington, DC, to 15% for boys in Mississippi. The team also found a positive correlation between uptake and HPV education legislation and pediatrician availability.
In a related commentary in the same issue, Amanda Dempsey, MD, PhD, MPH, with the University of Colorado, said the study was well powered to look at differences in vaccination coverage, was positioned to look at coverage over time, and assessed about 800,000 kids who were continuously insured.
She notes that those features yielded two unique insights: that vaccination levels were reached faster as the years went by and that one-dose coverage is projected to reach 80% by 2022 in 17-year-olds, when many haven't been exposed to disease-causing HPV types—a major public health victory.
Sep 14 Pediatrics study
Sep 14 Pediatrics commentary