Parental Decolonization Reduces NICU S. Aureus Infections

Treating parents with intranasal mupirocin and chlorhexidine-impregnated cloths can significantly reduce Staphylococcus aureus transmission to neonates, according to a new study.

Researchers at the Johns Hopkins University School of Medicine (JHU-SOM; Baltimore, MD, USA) conducted a study to test whether treating parents with intranasal mupirocin and topical chlorhexidine could reduce transmission of Staphylococcus aureus, a leading cause of health care-associated infections in the neonatal intensive care unit (NICU). The study included 236 neonates whose parents were colonized. Of these, 117 parents received intranasal mupirocin and 2% chlorhexidine-impregnated cloths (active group), and 119 received petrolatum intranasal ointment and non-medicated soap cloths (placebo group).

The primary end point was concordant colonization by 90 days, defined as neonatal acquisition of an S aureus strain that was the same strain as a parental strain at time of screening. The results revealed that about 22% of the neonates acquired S. aureus that matched bacteria recovered from their parents. But while nearly 29% of babies in the parental placebo group had transmitted bacteria, only 15% of those whose parents were in the active treatment group were colonized. The study was published on December 30, 2019, in JAMA.

“Traditional procedures for preventing hospital-acquired Staph infections in the NICU have primarily focused on keeping staff and facilities as sterile as possible. Our study is among the first to focus on parents as a source of the bacteria,” said lead author Professor Aaron Milstone, MD, MHS. “It is our hope that one day this technique can be combined with personal cleanliness for medical staff and environmental safety protocols for facilities to provide a stronger defense against NICU-acquired infections.”

Chlorhexidine salts dissociate and release the positively charged chlorhexidine cation molecule, which causes a bactericidal effect by binding to negatively charged bacterial cell walls. At low concentrations, a bacteriostatic effect occurs; at high concentrations, membrane disruption results in cell death. It can be applied topically as a gel, wash, or powder. Mupirocin is a topical antibiotic of the monoxycarbolic acid class which is bacteriostatic at low concentrations and bactericidal at high concentrations.

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