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Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identifi-cation of specific risk factors supports pre-vention of candidemia in neonates. Effec-tive prophylactic strategies have recently become available, but the identification and adequate management of high-risk in-fants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor in-cidence, species distribution, and antifun-gal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (10.17%) pa-tients tested positive for Candida spp. (C.), at least on one occasion. All the colonized patients tested positive for the rectal swab, whereas 7 patients also tested positive for the nasal swab. Fifteen out of 472 patients (3.18%) had more than one positive rec-tal or nasal swab during their NICU stay. Moreover, 9 out of 15 patients tested nega-tive at the first sampling, suggesting they acquired Candida spp. during their stay. Twenty-five of forty-eight (52.1%) colo-nized patients carried C.albicans and 15/48 (31.25%) C.parapsilosis. We identified as risk factors for Candida spp. colonization: antibiotic therapy, parenteral nutrition, the use of a central venous catheter, and nasogastric tube. Our experience suggests that effective microbiological surveillance can allow for implementing proper, effec-tive and timely control measures in a high-risk setting.

This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicilline-sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

A novel thermal treatment for microorganism inactivation, characterized by a very rapid temperature increase (up to 30C/s) and a low final temperature (up to 65C) maintained for a relatively short holding time, has been recently presented and tested by the authors, showing microbial load reduction greater than 5 log units against several common bacteria and yeasts. With the aim of extending the possible use of the new thermal treatment to a wider microorganisms class, in this work the dynamic irreversible thermoporation (DIT) treatment was further tested on a well-known thermoresistant strain, the Enterococcus hirae: The results of these new experimental tests confirmed the reliability of the process, which allowed to reach the 5 log microbial reduction once the adequate holding time was employed. The comparison with simple immersion in a thermostatic bath, where the very slow heating process with 0.3C/s has been performed, confirmed the crucial role of the thermal shock for the success of the treatment. The inactivation kinetics of E. hirae in isothermal conditions immediately after the application of thermal shock has also been studied. Finally, the morphological analysis performed by using a scanning electron microscope clearly revealed the rupture of the cell membrane, leading to identification of the process called dynamic irreversible thermoporation (DIT).

Colonization and/or infection with multidrug-resistant microorganisms (MDRO) of pressure ulcers in patients receiving care at home have seldom been investigated. The objective of this study was to assess the prevalence of MDRO colonization in pressure ulcers of patients receiving home care in Palermo, Italy. Vancomycin-resistant Enterococcus (VRE), methicillinresistant Staphylococcus aureus (MRSA), and multidrug-resistant Gram-negative bacilli (MDRGN) were isolated, identifi ed, and characterized from pressure ulcers and selected home environment surfaces. Thirty-two patients were enrolled, of whom 12 were under antimicrobial therapy. Five patients had been admitted to hospital in the preceding year. Nineteen patients tested positive for 1 or more MDROs. In particular, 1 patient was colonized by a vanA-containing strain of VRE, 5 by MRSA, and 17 by MDRGN of different species. Our fi ndings suggest that pressure ulcers in home care patients could play a role in bringing MDROs into the community setting.

Introduction Multidrug-resistant organisms are a serious public health problem, particularly in critical hospital wards such as the Neonatal Intensive Care Units (NICUs). Hospitalized neonates are at high risk for healthcare-associated infections leading to higher morbidity and mortality rates, because of their poor immune defences, frequent exposure to antibiotics, invasive procedures and contacts with healthcare-workers. Our study aimed to evaluate the prevalence of colonization by methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negatives (MDRGNs) and fungi in the five NICUs of the city of Palermo. Methods From February 2014 to January 2015, an active surveillance culture (ACS) program was set up in the five NICUs of Palermo (ARNAS Civico-NICU1, Ingrassia Hospital-NICU2, Villa Sofia-Cervello Hospital-NICU3, Buccheri La Ferla Hospital-NICU4 and AOUP "Paolo Giaccone"-NICU5). From each patient nasal and rectal swabs were monthly collected to look for MRSA, MDRGNs and fungi. Swabs were pre-incubated at 37°C overnight in BHI enrichment broth, and cultured on selective media. Suspected S. aureus colonies were confirmed by cefoxitin susceptibility testing. MDRGNs were selected by antibiotic disk screening and tested to detect extended-spectrum beta-lactamase” (ESBL) and carbapenemase-producing isolates. For fungal detection swabs were directly inoculated on chloramphenicol-Sabouraud dextrose agar plates and incubated at 30°C for 72 hrs. Yeast-like colonies were identified by subculturing on CHROMagar Candida and eventually confirmed by the API20CAUX test. Prevalence rates of colonization of the different NICUs were compared by the chi-square test. Results The average daily number of hospitalized patients was 16 in NICU1, 9 in NICU2, 21 in NICU3, 15 in NICU4, 11 in NICU5. Prevalence of MRSA colonization ranged between 3.6% in NICU3 and 28.8% in NICU4, showing statistically significant differences between the NICUs. Prevalence of colonization by MDRGNs ranged between 53.9% for NICU1 and 14% for NICU4 with statistically significant differences between the NICUs. The most frequently isolated MDRGN organisms were Klebsiella pneumoniae, Escherichia coli and Enterobacter spp., with a prevalence between 1.9% and 57.2% for ESBL-producing and between 0% and 3.5% for carbapenemase-producing isolates. Fungal colonization was never detected in NICU2, whilst the highest prevalence values were 7.2% for C. albicans in NICU4 and 5.9% for non-albicans Candida spp. in NICU5. Statistically significant differences were found. Discussion Spread of multidrug-resistant organisms proved to affect all the NICUs under investigation, with a higher prevalence of MRSA in NICUs 4 and 2 and a higher prevalence of MDRGNs in NICUs 1 and 5. Fungal colonization prevalence was different between the NICUs with NICU4 being more affected by C.albicans and NICU5 by non-albicans Candida spp. These differences could be attributable to different structural and organizational characteristics and the recurrent epidemic spread of some organisms by cross-transmission. The widespread dissemination of MRSA and ESBL producing isolates and the emergence of carbapenem-resistant Enterobacteriaceae require a continuous effort in implementing preventive measures, control interventions and staff training.

D. M. Geraci, C. Bonura, M. Giuffre, L. Saporito, G. Graziano, A. Aleo, T. Fasciana, F. Di Bernardo, T. Stampone, D. M. Palma and C. Mammina 1) Department of Sciences for Health Promotion and Mother-Child Care ‘G. D’Alessandro’, University of Palermo, 2) Postgraduate Specialty School in Hygiene and Preventive Medicine, University of Palermo, 3) Laboratory of Microbiology, General Hospital ARNAS ‘Civico, Di Cristina & Benfratelli’, 4) Laboratory of Microbiology, General Hospital Azienda Ospedaliera ‘Villa Sofia-V, Cervello’ and 5) II Intensive Care Unit, General Hospital ARNAS ‘Civico, Di Cristina & Benfratelli’, Palermo, Italy

INTRODUZIONE: La Sicilia è notoriamente terra endemica per la leishmaniosi, ma mancano, allo stato attuale, dei sistemi di sorveglianza attiva che permettano di quantificare precisamente il carico di malattia attribuibile a questa patologia protozoaria. Obiettivo del presente lavoro è stato quello di analizzare i flussi sanitari correnti disponibili al fine di stimare l’impatto della leishmaniosi sulla popolazione siciliana residente. MATERIALI E METODI: Lo studio ha analizzato due fonti: a) tutte le notifiche in classe II di leishmaniosi effettuate tra gennaio 2010 e dicembre 2013; b) le schede di dimissione ospedaliera (SDO) riportanti i codici ICD9-CM 085.1, 085.2, 085.3, 085.4, 085.5 ed 085.9 in diagnosi principale o secondaria e prodotte nel periodo 2009-2012. Per ciascuna delle due fonti si è provveduto ad analizzare dati socio-demografici (età e sesso) e caratteristiche cliniche delle malattia in esame. RISULTATI: Nel periodo in studio sono pervenute 137 notifiche di cui 103 (75,2%) di leishmaniosi cutanea e 34 (24,8%) di leishmaniosi viscerale. La maggior parte delle notifiche si è registrata nel 2013 (83; 60,6%) mentre negli altri anni sono stati notificati 26, 15 e 13 casi (2010, 2011 e 2012, rispettivamente). Leishmaniosi viscerale e cutanea hanno mostrato una simile distribuzione per età con una larga parte dei casi che ha interessato le fasce 0-14 anni (47 casi; 34,3%) e 25-64 anni (59 casi; 43,1%). Circa il 54,8% dei casi si è verificato in soggetti di sesso femminile (età mediana 44 anni) mentre il restante 45,2% in soggetti di sesso maschile (età mediana 40,5 anni). Il 71% delle notifiche proveniva da soggetti residenti nelle province di Agrigento (61; 45,2%) e Palermo (35; 25,9%). Relativamente ai ricoveri, tra 2009 e 2012 sono state prodotte 522 SDO con codici suggestivi di leishmaniosi nelle seguenti varianti: 230 (44%) viscerale, 102 (20%) cutanea, 29 (6%) americana, 9 (2%) mucocutanea ed infine 148 (28%) forme non specificate. Una larga fetta di ricoveri è stata effettuata in soggetti residenti nelle province di Catania (192; 36,8%), Palermo (179; 34,3%) e Caltanissetta (42; 8%). In media è stato possibile stimare un tasso di ricovero paria a 2,6 casi/100.000 per anno. CONCLUSIONI: I dati prodotti dall’analisi dei flussi sanitari correnti hanno confermato che la leishmaniosi in Sicilia continua ad essere una patologia endemica capace di assorbire importanti risorse sanitarie ed economiche. La comparazione dei dati di notifica con quelli di ricovero sembra inoltre confermare un alto tasso di sottonotifica, particolarmente evidente in alcune province. Visto il peso della patologia risulterebbe auspicabile implementare dei sistemi regionali di sorveglianza attiva ed aumentare la sensibilità degli operatori sanitari nei confronti della notifica obbligatoria.

Objectives Surveillance cultures are of great importance to detect the emergence of multidrug resistant (MDR) bacteria in high-risk settings and prevent the occurrence of colonization and clinical infection cases. We report the isolation of OXA-48-harbouring Klebsiella pneumoniae sequence type (ST) 530 in a Neonatal Intensive Care Unit (NICU) in Palermo, Italy. Methods Since June 2009, a routine surveillance protocol is in place in the NICU of the University Hospital of Palermo, including nasal and rectal swabs obtained on a weekly basis to monitor the prevalence of colonization by methicillin- resistant Staphylococcus aureus, MDR Gram-negatives and glycopeptide-resistant enterococci. Enteric colonization by antibiotic-resistant Gram negatives is assessed by culturing overnight broth-enriched rectal swabs onto MacConkey agar plates with disks of meropenem (10 mg) and ceftazidime (30 mg). Colonies growing within antibiotic inhibition zones are subcultured, biochemically identified and submitted to antimicrobial susceptibility testing by disk diffusion method and E-test and to ESBL detection according with the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Beta-lactamase genes are identified by polymerase chain reaction (PCR) amplification and sequencing. Multilocus sequence typing (MLST) is performed and STs are determined using the K. pneumoniae MLST database (http://www.pasteur.fr/recherche/genopole/PF8/mlst/Kpneumoniae.html). Results In September 2013 an isolate of OXA-48 carbapenemase producing K. pneumoniae was identified from a newborn admitted from another hospital. Antimicrobial susceptibility testing showed susceptibility to 3rd and 4th generation cephalosporins and to aminoglycosides, intermediate suceptibility to imipenem and meropenem and resistance to ertapenem. PCR amplification tested positive for blaOXA-48 gene, and negative for other beta-lactamase genes. The isolate was identified as K. pneumoniae ST530 by MLST. The patient stayed in the NICU for five weeks, and OXA-48 K. pneumoniae colonization was confirmed at every weekly screening. During the last two weeks a second newborn tested positive for K. pneumoniae with a similar antimicrobial resistance pattern, which was confirmed to belong to ST530. Infection control prevention measures were strenghtened. The two colonized patients were discharged in mid-October and no further cases were detected. Conclusions Carbapenem-resistant Enterobacteriaceae are an emerging threat in Europe, particularly in the Mediterranean basin. The frequent horizontal transmission of plasmid-related resistance genes among different strains and species is allowing the epidemic diffusion of such MDR organisms in Europe in the last years. The remarkable potential for causing invasive infections and the limited therapeutic options associated with high mortality rates are of great concern. The implementation of surveillance programmes and infection control measures particularly in high-risk settings should be considered an essential strategy for public health interventions.

Background: Methicillin resistant Staphylococcus aureus (MRSA) is a major etiological agent of infection in neonatal intensive care units (NICUs). Routes of entry of this organism can be different and the transmission pathway complex. Colonized neonates are the main endogenous reservoir. Methods and Results: We conducted a prospective three-year study on MRSA colonization recruiting 722 neonates admitted between 2009 and 2012. Nasal swabs were cultured weekly and MRSA isolates were submitted to molecular typing. The annual incidence density of acquisition of MRSA ranged from a maximum of 20.2 cases for 1000 patient-days during the first year to a minimum of 8.8 cases in the second one to raise again up to 13.1 cases during the third year. The mean weekly colonization pressure fluctuated from 19.1% in the first year to 13.4% in the second year and 16.8% in the third year. It significantly correlated with the number of MRSA acquisitions in the following week. Overall, 187 (25.9%) subjects tested positive for MRSA. A non multiresistant, tst positive, ST22-MRSA-IVa spa t223 strain proved to be endemic in the NICU, being identified in 166 (88.8%) out of 187 colonized neonates. Sporadic or epidemic occurrence of other strains was detected. Conclusions: An MRSA strain belonging to the tst1 positive, UK-EMRSA-15/ ‘‘Middle Eastern Variant’’ appeared to be endemic in the NICU under investigation. During the three-year period, substantial changes occurred in case-mix of patients moving towards a higher susceptibility to MRSA colonization. The infection control procedures were able to decrease the colonization rate from more than 40% to approximately 10%, except for an outbreak due to a CA-MRSA strain, ST1-MRSAIVa, and a transient increase in the colonization prevalence rate coincident with a period of substantial overcrowding of the ward. Active surveillance and molecular typing contributed to obtain a reliable picture of the MRSA dissemination in NICU.

In developed countries about 10% of the hospitalizations are complicated by a healthcare-associated infection [1]. Up to 75% of these infections are due to multidrug-resistant organisms (MDROs) [1]. Antimicrobial resistant bacterial infections are associated to higher morbidity, mortality and healthcare costs than those caused by susceptible organisms [1]. The findings of the point prevalence survey in European acute care hospitals published in 2013 by the European Centre for Disease Control and Prevention (ECDC) show large variations between countries and between different regions of the same country, with Italy being allocated within the high-endemic areas for both MRSA and MDROs [2]. Despite antimicrobial resistance affects most bacterial species, MDR Gram negatives represent the most serious threat. In a few years Enterobacteriaceae, mainly Escherichia coli and Klebsiella pneumoniae, have evolved from extended spectrum β-lactamase (ESBL) producing to carbapanem-resistant organisms [3]. Simultaneously, Acinetobacter baumannii has quickly become extremely or pan-drug resistant [4]. Carbapenem resistant Gram negatives heavily impact on clinical outcomes with mortality rates significantly higher than the susceptible strains of the same species [1]. Of further concern, very few antimicrobial agents are available for an effective treatment of these infections and new agents active against these organisms are not currently in development. Many intertwining factors are driving these epidemiological changes, involving patients, healthcare delivery systems, infection control practices and, most important, misuse and inappropriate use of antibiotics in all healthcare facilities, in community and in animal husbandry. In particular, the transition of the healthcare delivery systems from a hospital-centered model to a healthcare facility network has gradually blurred the borders between hospital and community and the patients’ travel within this network has critically contributed to disseminate MDROs [5]. As a consequence, antimicrobial resistance is now as common, if not more so, in post-acute clinical facilities, such as long term care settings and nursing homes [5]. The “revolving door” is the very efficacious image used as the paradygm of the spreading routes of organisms with hospital and community reservoirs, as E. coli or MRSA. The revolving door, indeed, enlightens how the colonized patients entering back and forth several healthcare settings drive the amplification of the antibiotic resistance [6]. Stringent infection control and prevention practices and wise use of antibiotics are unanimously agreed as the key actions to fight MDROs. Of course, we need new antibiotics, but first we have to learn how to protect them from a precipitous erosion of their effectiveness.

Background Extended spectrum β-lactamases (ESBLs) often associated with resistance to aminoglycosides and fluoroquinolones have recently emerged in community-associated Escherichia coli. The worldwide clonal dissemination of E. coli sequence type (ST)131 is playing a prominent role. We describe an outbreak of colonizations by ESBL-producing E. coli (ESBL-E. coli) in the neonatal intensive care unit (NICU) of the University Hospital, Palermo, Italy. Methods An epidemiological investigation was conducted with the support of molecular typing. All children admitted to the NICU and colonized by ESBL-E. coli between January and June 2012, were included in the study. Cases were defined as infants colonized by E. coli resistant to third generation cephalosporins and fluoroquinolones. A case–control study was also performed to identify possible risk factors. Results During the outbreak period, 15 infants were found to be colonized by ESBL-E. coli. The epidemic strain demonstrated continuous transmission throughout the outbreak period. Case–control study identified a lower birth weight as the only risk factor for colonization. The strain belonged to the sequence-type 131 community-associated clone. Transmission control interventions, including contact precautions and cohorting, restriction of the new admissions, sanitization of surfaces and equipment and targeted training sessions of the NICU staff, were successful in interrupting the outbreak. Conclusions Although invasive infections did not develop in any of the 15 colonized neonates, our report highlights the need to strictly monitor the spill in the NICU setting of multidrug resistant community-associated organisms. Our findings confirm also the role of active surveillance in detecting the silent spread of ESBL-producing Gram negatives in a critical healthcare setting and trigging the implementation of infection control measures. As β-lactam and fluoroquinolone resistant E. coli strains are increasingly spreading in the community, this event could become a more serious challenge.

INTRODUZIONE: La diffusione della resistenza batterica, sia in ospedale che in comunità, costituisce un serio motivo di allarme. La disseminazione di microrganismi resistenti in ospedale, particolarmente accentuata in reparti critici quali le terapie intensive, è favorita oltre che dall’uso dei farmaci antimicrobici, da procedure chirurgiche e/o invasive, dalla presenza di pazienti compromessi e dal trasferimento da una struttura sanitaria ad un’altra di pazienti colonizzati o infetti. Una conoscenza dettagliata dell’entità del fenomeno e dei principali microrganismi antibiotico-resistenti in ambito nosocomiale è essenziale per lo sviluppo di strategie volte a prevenire tale fenomeno. In questo contesto la sorveglianza delle resistenze agli antimicrobici è ritenuta un elemento cruciale per la prevenzione e il controllo della loro diffusione. Il nostro studio si è proposto di valutare la prevalenza delle colonizzazioni da Staphylococcus aureus meticillino-resistente (MRSA) e da gram-negativi multi-resistenti (MDRGN) nelle Unità di Terapia Intensiva Neonatale (UTIN) di Palermo. MATERIALI E METODI: Dal Giugno 2009 è in atto un programma di sorveglianza settimanale delle colonizzazioni da microrganismi multi-resistenti presso l’UTIN dell’AOUP “Paolo Giaccone” di Palermo. Da Febbraio 2014 la sorveglianza è stata estesa con cadenza mensile alle UTIN degli altri ospedali della città (ARNAS Civico-Di Cristina-Benfratelli, UTIN1, Ospedali Riuniti Villa SofiaCervello, UTIN2, Presidio Ospedaliero G.F. Ingrassia, UTIN3, Ospedale Buccheri La Ferla Fatebenefratelli UTIN4). Per ciascun paziente è stato effettuato un tampone nasale per la ricerca di MRSA ed uno rettale per la ricerca di MDRGN. I tamponi sono stati incubati a 37°C per 24 ore in brodo di arricchimento, e successivamente seminati in terreni selettivi. In particolare, i tamponi nasali sono stati seminati in agar sale-mannite; dopo 48 ore di incubazione, le colonie con aspetto caratteristico di S. aureus sono state identificate e trasferite in Mueller-Hinton con supplemento di oxacillina 6 mg/L. I ceppi resistenti sono stati confermati come MRSA con il test di sensibilità alla cefoxitina. I tamponi rettali sono stati sottoposti ad uno screening iniziale in agar McConkey in presenza di 4 dischetti di antibiotici (gentamicina 10 μg, amoxicillinaacido clavulanico 20-10 μg, meropenem 10 μg, ceftazidime 30 μg). I ceppi di MDRGN isolati sono stati identificati e sottoposti al Double-disk synergy test (DDST) per il rilevamento delle betalattamasi a spettro esteso (ESBL) e a screening fenotipico per la produzione di carbapenemasi con il test di diffusione da disco (meropenem 10 μg, imipenem 10 µg, ertapenem 10 µg) secondo le linee-guida del European Committee on Antimicrobial Susceptibility Testing (EUCAST). E’ stata stimata e confrontata la prevalenza delle colonizzazioni all’interno delle varie UTIN e il trend temporale. RISULTATI: Le cinque UTIN oggetto dello studio sono distribuite su tutto il territorio cittadino e presentano capacità diverse. Il numero medio giornaliero di pazienti ricoverati è stato di 14 presso l’UTIN1, 8 presso l’UTIN2, 19 presso l’UTIN3, 13 presso l’UTIN4, 12 presso l’UTIN dell’AOUP “Paolo Giaccone” (UTIN 5). La colonizzazione da MRSA è stata rilevata in tutte le UTIN esaminate ad eccezione della UTIN3 (Fig.1). I livelli più elevati di prevalenza sono stati osservati presso l’UTIN2 (44,4%) e l’UTIN 4 (37,5%). La prevalenza di MDRGN ha presentato valori variabili da un massimo del 100% per l’UTIN1 ad un minimo del 10% per l’UTIN4 (Fig.2). Klebsiella pneumoniae è stato il microrganismo isolato più frequentemente (2,6%-86,0% nelle varie UTIN), seguito da Escherichia coli (0-16,7%). La presenza di ESBL è stata rilevata nel 93,9% degli isolati di K. pneumoniae e nel 71,9% dei ceppi di E. coli. La resistenza ai carbapenemi è stata riscontrata in 5 isolati di K. pneumoniae e in 4 isolati di E. coli. CONCLUSIONI: Il programma di sorveglianza ha confermato che la circolazione di microrganismi multiresistenti interessa tutte le UTIN esaminate, seppure con rilevanti differenze. Ciascuna UTIN sembra avere una propria ecologia microbica, con una predominanza di MRSA o di MDRGN o con una bassa prevalenza di entrambi. Le differenze osservate potrebbero essere ascrivibili alle diverse caratteristiche strutturali ed organizzative (dimensioni dei locali, spazio tra le culle, numerosità dei posti letto e del personale, tipologia di ricoveri, politica di uso degli antibiotici). L’ampia diffusione di ceppi ESBL positivi e l’emergenza di microrganismi resistenti ai carbapenemi impongono un costante sforzo nell’attuazione rigorosa di misure di prevenzione e controllo e di interventi di formazione del personale.

Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has recently emerged as an important pathogen in neonatal intensive care units (NICUs). The purposes of this study were to characterize methicillin-resistant isolates from an outbreak in a NICU, to examine the genetic traits and clonality of CA-MRSA, and to review the characteristics and outcomes of the neonatal cases and investigate the routes of entry and transmission of the MRSA outbreak strain in the NICU under study. Methods The study NICU practiced an active surveillance program for multidrug-resistant organisms, including weekly cultures for detection of MRSA from nasal swabs among all the admitted neonates. All first isolates from surveillance cultures and all clinical isolates were submitted for susceptibility testing and genotyping. Data from each infant’s medical records were prospectively included in a database, and the clinical features and outcomes of the colonized/infected infants were assessed. Results A total of 14 infants were colonized or infected by a strain of ST1-MRSA-IVa between April and August 2011. The CA-MRSA strain appeared to have been introduced to the NICU by an infected infant transferred from another hospital. The outbreak was successfully contained by multifaceted infection control interventions. Conclusions The results of this study confirm that NICU is a healthcare setting with a critical permeability to CA-MRSA. Active surveillance including molecular typing can help to detect and monitor the spread of antimicrobial drug-resistant organisms, and thus trigger timely control interventions.