Staphylococcus capitis: guidance, data and analysis
Findings from a 2021 to 2022 incident response by the UK Health Security Agency (UKHSA) to Staphylococcus capitis in UK neonatal units.
Staphylococcus capitis (S. capitis) is a coagulase-negative Staphylococcus (CoNS) species, which is found on skin as part of the natural flora, and rarely causes invasive disease outside of the neonatal period. It has caused sporadic outbreaks associated with neonatal late-onset sepsis since the late 1990s. The role of S. capitis in infections and outbreaks is described in a review of the literature.
By 2012, it was recognised that a clone of S. capitis, known as the NRCS-A strain, was widespread in neonatal intensive care units (NICUs) across the UK, and caused significant outbreaks. This strain was previously reported to have meticillin resistance, vancomycin hetero-resistance and specific aminoglycoside resistance. Extensive use of vancomycin is thought to have driven its expansion.
Environment
UKHSA conducted environmental work in NICUs with and without known NRCS-A colonisations or infections present at the time of sampling. While S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection.
There was no evidence to suggest that detergents and disinfectants commonly used in healthcare settings would be ineffective against S. capitis. However, in limited studies, one disinfectant did not eliminate some NRCS-A strains within the required contact time. In addition, disinfection failures may be exacerbated by the design of equipment and the environment found in NICUs. It is important that detergents and disinfectants are used appropriately and in accordance with manufacturers’ instructions; in addition, the mechanical action of standard cleaning processes cannot be understated.
More research is needed to better understand the role of neonatal incubators in the transmission of S. capitis in NICUs.
Clinical management
A commentary letter was published, highlighting the unmet need to review vancomycin use in neonatal units and antimicrobial stewardship. Research in this area is ongoing, as part of the National Institute for Health and Care Research (NIHR) Health Protection Research Unit collaboration with Imperial College London.
Infection prevention guidance for neonatal settings
A peer-reviewed statement reinforcing good infection prevention and control practice for the management of incubators in a neonatal setting was published.
Colleagues from the Paediatric Infection Prevention Improvement Network (PIPIN) are currently drafting national guidance on neonatal incubator decontamination.
Epidemiology
Reports of CoNS from normally sterile body sites in patients in England increased between 2010 and 2016 and remained stable between 2017 and 2021. There has been a striking improvement in species-level identification of CoNS in recent years, which has likely contributed to the increased detection of S. capitis.
However, whole-genome sequencing revealed widespread presence of S. capitis NRCS-A clone in neonatal units across the UK, with the first documented appearance in 1999, and evidence suggesting intra- and inter-regional transmission.
A case-control study investigating the impact on health outcomes showed no difference in mortality in infants with invasive S. capitis infection compared to other CoNS.
The reference laboratory still welcomes isolates related to a cluster or an outbreak to be submitted for typing by the following forms:
Further guidance for neonatal settings
A peer-reviewed statement reinforcing good infection prevention and control (IPC) practice for the management of incubators in a neonatal setting is available.
Last updated 29 September 2023 + show all updates
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Added link to a case-control study.
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Added links to peer-reviewed publications.
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Added link to a review of the role of Staphylococcus capitis in infections and outbreaks.
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First published.