2020 Volume 69 Issue 2 Pages 229-234
Surveillance culture tests in the neonatal intensive care unit (NICU) are widely implemented to monitor horizontal transmissions and choose appropriate antimicrobials when patients have late-onset infections. However, the efficiency of surveillance culture tests has not been accurately evaluated. We examined the detection rates and costs before and after the change in the protocol of surveillance culture tests in 2017 from 2012 to March 2019 and determined the most efficient monitoring culture. Until 2016, NICU performed biweekly nasal swabs and fecal and navel examinations of all hospitalized patients. However, this surveillance method did not seem to be optimally cost-efficient because retrospective analyses of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) isolates revealed that MRSA and MSSA were detected more often in nasal swab samples and subsequently colonized in most infants carrying them. Therefore, to be cost-efficient, we considered in 2017 to limit surveillance culture sampling to nasal swabs. As a result, we found that despite these changes, we found that the MRSA and MSSA detection rates did not significantly decrease, with a 65% decrease in sample number and a 73% decrease in cost compared with those in the 2018 surveillance culture tests. In conclusion, we found that there is less need to perform nasal swab and fecal and navel examinations simultaneously in surveillance culture tests. We showed that a protocol of surveillance culture tests targeting MRSA and MSSA by nasal swabs alone is cost-efficient.
