Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in...

Area of Science:

• Neonatal Intensive Care Unit (NICU) infection control
• Antimicrobial stewardship
• Infectious disease epidemiology

Background:

• Neonatal intensive care units (NICUs) are high-risk environments for Staphylococcus aureus (S. aureus) colonization and infection.
• Controlling S. aureus is crucial for preventing serious neonatal infections, including methicillin-resistant and methicillin-sensitive strains.

Purpose of the Study:

• To evaluate the effectiveness of long-term prophylactic mupirocin application in reducing S. aureus colonization and infection rates within a NICU.
• To assess the impact of mupirocin on S. aureus outbreaks and overall infection incidence.

Main Methods:

• A retrospective review was conducted on infants admitted to the NICU between 2004 and 2010.
• Mupirocin was applied twice daily to all admitted infants throughout their hospitalization, starting in 2004.
• S. aureus surveillance data was collected from 2008 onwards to assess infection and colonization rates.

Main Results:

• S. aureus infection rates decreased significantly from 1.82 to 0.40 per 1000 patient-days after initial mupirocin implementation (P=0.0049).
• Following a temporary discontinuation and subsequent reinstitution of mupirocin, infection rates further decreased from 1.42 to 0.33 per 1000 patient-days (P<0.0001).
• S. aureus colonization rates dropped from over 60% to below 5%, and colonization was a strong predictor of invasive infection (P<0.0001).

Conclusions:

• Prophylactic mupirocin, despite being controversial, effectively reduced S. aureus colonization and markedly decreased infection rates in the NICU over a five-year period.
• The use of mupirocin acted as a significant barrier against S. aureus transmission and infection in this vulnerable neonatal population.