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Effect of Treating Parents Colonized With Staphylococcus aureus on Transmission to Neonates in the Intensive Care
Aaron M Milstone1,2,3, Annie Voskertchian1, Danielle W Koontz1
1Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Treating parents with mupirocin and chlorhexidine significantly reduced Staphylococcus aureus transmission to neonates in the NICU. This intervention lowered concordant S aureus colonization, a key factor in invasive disease.
Area of Science:
- Neonatal Intensive Care Unit (NICU) infections
- Infectious disease transmission
- Clinical microbiology
Background:
- Staphylococcus aureus is a major cause of healthcare-associated infections in NICUs.
- Parental S aureus colonization is a significant risk factor for invasive S aureus disease in neonates.
Purpose of the Study:
- To evaluate the efficacy of treating parents with intranasal mupirocin and topical chlorhexidine in reducing S aureus transmission to neonates.
- To assess the impact of parental decolonization on concordant S aureus colonization in neonates.
Main Methods:
- A double-blinded randomized clinical trial was conducted in two tertiary NICUs.
- Parents of S aureus-colonized neonates received either intranasal mupirocin/chlorhexidine cloths or placebo for five days.
- Primary endpoint was concordant S aureus colonization at 90 days.
Main Results:
- Concordant S aureus colonization was significantly reduced in the intervention group (14.6%) compared to placebo (28.7%).
- Overall S aureus acquisition was also lower in neonates whose parents received active treatment.
- No significant difference in S aureus infections or adverse skin reactions between groups.
Conclusions:
- Parental treatment with intranasal mupirocin and chlorhexidine cloths is a promising strategy to reduce S aureus transmission to neonates.
- This intervention may decrease the risk of invasive S aureus disease in vulnerable infant populations.
- Further research is needed to confirm findings and assess generalizability.
Importance:
Staphylococcus aureus is a leading cause of health care-associated infections in the neonatal intensive care unit (NICU). Parents may expose neonates to S aureus colonization, a well-established predisposing factor to invasive S aureus disease.
Objective:
To test whether treating parents with intranasal mupirocin and topical chlorhexidine compared with placebo would reduce transmission of S aureus from parents to neonates.
Design, Setting, And Participants:
Double-blinded randomized clinical trial in 2 tertiary NICUs in Baltimore, Maryland. Neonates (n = 236) with S aureus-colonized parent(s) were enrolled. The study period was November 7, 2014, through December 13, 2018.
Interventions:
Parents were assigned to intranasal mupirocin and 2% chlorhexidine-impregnated cloths (active treatment, n = 117) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo, n = 119) for 5 days.
Main Outcomes And Measures:
The primary end point was concordant S aureus 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. Secondary outcomes included neonatal acquisition of any S aureus strain and neonatal S aureus infections.
Results:
Among 236 randomized neonates, 208 were included in the analytic sample (55% male; 76% singleton births; mean birth weight, 1985 g [SD, 958 g]; 76% vaginal birth; mean parent age, 31 [SD, 7] years), of whom 18 were lost to follow-up. Among 190 neonates included in the analysis, 74 (38.9%) acquired S aureus colonization by 90 days, of which 42 (56.8%) had a strain concordant with a parental baseline strain. In the intervention and placebo groups, 13 of 89 neonates (14.6%) and 29 of 101 neonates (28.7%), respectively, acquired concordant S aureus colonization (risk difference, -14.1% [95% CI, -30.8% to -3.9%]; hazard ratio [HR], 0.43 [95.2% CI, 0.16 to 0.79]). A total of 28 of 89 neonates (31.4%) in the intervention group and 46 of 101 (45.5%) in the control group acquired any S aureus strain (HR, 0.57 [95% CI, 0.31 to 0.88]), and 1 neonate (1.1%) in the intervention group and 1 neonate (1.0%) in the control group developed an S aureus infection before colonization. Skin reactions in parents were common (4.8% intervention, 6.2% placebo).
Conclusions And Relevance:
In this preliminary trial of parents colonized with S aureus, treatment with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced neonatal colonization with an S aureus strain concordant with a parental baseline strain. However, further research is needed to replicate these findings and to assess their generalizability.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02223520.
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