Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-03T14:31:30.022Z Has data issue: false hasContentIssue false

Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study

Published online by Cambridge University Press:  05 June 2017

Rebecca Pierce*
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Kristina Bryant
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
Alexis Elward
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
Justin Lessler
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Aaron M. Milstone*
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Address correspondence to Rebecca Pierce, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E6008, Baltimore, MD 21287 (rpierc13@jhu.edu) or Aaron Milstone, Johns Hopkins Department of Pediatric Infectious Diseases, 200 North Wolfe St., Rubenstein 3141, Baltimore, MD 21287 (amilsto1@jhmi.edu).
Address correspondence to Rebecca Pierce, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E6008, Baltimore, MD 21287 (rpierc13@jhu.edu) or Aaron Milstone, Johns Hopkins Department of Pediatric Infectious Diseases, 200 North Wolfe St., Rubenstein 3141, Baltimore, MD 21287 (amilsto1@jhmi.edu).

Abstract

OBJECTIVE

To characterize the risk of infection after MRSA decolonization with intranasal mupirocin.

DESIGN

Multicenter, retrospective cohort study.

SETTING

Tertiary care neonatal intensive care units (NICUs) from 3 urban hospitals in the United States ranging in size from 45 to 100 beds.

METHODS

MRSA-colonized neonates were identified from NICU admissions occurring from January 2007 to December 2014, during which a targeted decolonization strategy was used for MRSA control. In 2 time-to-event analyses, MRSA-colonized neonates were observed from the date of the first MRSA-positive surveillance screen until (1) the first occurrence of novel gram-positive cocci in sterile culture or discharge or (2) the first occurrence of novel gram-negative bacilli in sterile culture or discharge. Mupirocin exposure was treated as time varying.

RESULTS

A total of 522 MRSA-colonized neonates were identified from 16,144 neonates admitted to site NICUs. Of the MRSA-colonized neonates, 384 (74%) received mupirocin. Average time from positive culture to mupirocin treatment was 3.5 days (standard deviation, 7.2 days). The adjusted hazard of gram-positive cocci infection was 64% lower among mupirocin-exposed versus mupirocin-unexposed neonates (hazard ratio, 0.36; 95% confidence interval [CI], 0.17–0.76), whereas the adjusted hazard ratio of gram-negative bacilli infection comparing mupirocin-exposed and -unexposed neonates was 1.05 (95% CI, 0.42–2.62).

CONCLUSIONS

In this multicentered cohort of MRSA-colonized neonates, mupirocin-based decolonization treatment appeared to decrease the risk of infection with select gram-positive organisms as intended, and the treatment was not significantly associated with risk of subsequent infections with organisms not covered by mupirocin’s spectrum of activity.

Infect Control Hosp Epidemiol 2017;38:930–936

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Zingg, W, Hopkins, S, Gayet-Ageron, A, Holmes, A, Sharland, M, Suetens, C. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. Lancet Infect Dis 2017;17:381389.CrossRefGoogle ScholarPubMed
2. Popoola, VO, Milstone, AM. Decolonization to prevent Staphylococcus aureus transmission and infections in the neonatal intensive care unit. J Perinatol 2014;34:805810.CrossRefGoogle ScholarPubMed
3. Nelson, MU, Gallagher, PG. Methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit. Semin Perinatol 2012;36:424430.CrossRefGoogle ScholarPubMed
4. Slocombe, B, Perry, C. The antimicrobial activity of mupirocin-an update on resistance. J Hosp Infect 1991;19:1925.CrossRefGoogle ScholarPubMed
5. Sutherland, R, Boon, RJ, Griffin, KE, Masters, PJ, Slocombe, B, White, AR. Antibacterial activity of mupirocin (pseudomonic acid), a new antibiotic for topical use. Antimicrob Agents Chemother 1985;27:495498.CrossRefGoogle ScholarPubMed
6. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:22552265.CrossRefGoogle ScholarPubMed
7. Nelson, MU, Bizzarro, MJ, Dembry, LM, Baltimore, RS, Gallagher, PG. One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units. J Perinatol 2014;34:653655.CrossRefGoogle Scholar
8. GlaxoSmithKline. Bactroban(R) [Package Insert]. US Food and Drug Adminisstration website. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/050591s032,050703s015,050746s018lbl.pdf. Published 2014. Accessed February 3, 2017.Google Scholar
9. Costello, EK, Stagaman, K, Dethlefsen, L, Bohannan, BJM, Relman, DA. The application of ecological theory towards an understanding of the human microbiome. Science 2012;336:12551262.CrossRefGoogle Scholar
10. Willing, BP, Russell, SL, Brett Finlay, B. Shifting the balance: antibiotic effects on host–microbiota mutualism. Nat Rev Microbiol 2011;9:233243.CrossRefGoogle ScholarPubMed
11. Kallen, AJ, Jernigan, JA, Patel, PR. Decolonization to prevent infections with Staphylococcus aureus in patients undergoing hemodialysis: a review of current evidence. Semin Dial 2011;24:533539.CrossRefGoogle ScholarPubMed
12. Laupland, KB, Conly, JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: an evidence-based review. Clin Infect Dis 2003;37:933938.CrossRefGoogle ScholarPubMed
13. van Rijen, M, Bonten, M, Wenzel, R, Kluytmans, J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev 2008;4:CD006216.Google Scholar
14. Hocevar, SN, Edwards, JR, Horan, TC, et al. Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 2012;33:12001206.CrossRefGoogle Scholar
15. Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Pubished 2013. Accessed January 11, 2017.Google Scholar
16. Polin, RA, Denson, S, Brady, MT. Committee on Fetus and Newborn, Committee on Infectious Diseases. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics 2012;129:e1104e1109.CrossRefGoogle Scholar
17. Dominguez-Bello, MG, Costello, EK, Contreras, M, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci 2010;107:1197111975.CrossRefGoogle ScholarPubMed
18. Popoola, VO, Budd, A, Wittig, SM, et al. Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention. Infect Control Hosp Epidemiol 2014;35:412418.CrossRefGoogle Scholar
19. Pierce, R, Lessler, J, Popoola, VO, Milstone, AM. Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme. J Hosp Infect 2017;95:9197.CrossRefGoogle Scholar
20. Popoola, VO, Colantuoni, E, Suwantarat, N, et al. Active surveillance cultures and decolonization to reduce Staphylococcus aureus infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2016;37:381387.CrossRefGoogle ScholarPubMed
21. Huang, Y-C, Lien, R-I, Lin, T-Y. Effect of mupirocin decolonization on subsequent methicillin-resistant Staphylococcus aureus infection in infants in neonatal intensive care units. Pediatr Infect Dis J 2015;34:241245.CrossRefGoogle ScholarPubMed
22. Tsai, M-H, Chu, S-M, Hsu, J-F, et al. Risk factors and outcomes for multidrug-resistant gram-negative bacteremia in the NICU. Pediatrics 2014;133:e322e329.CrossRefGoogle ScholarPubMed
23. Pérez-Fontán, M, García-Falcón, T, Rosales, M, et al. Treatment of Staphylococcus aureus nasal carriers in continuous ambulatory peritoneal dialysis with mupirocin: long-term results. Am J Kidney Dis 1993;22:708712.CrossRefGoogle ScholarPubMed
24. Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group. J Am Soc Nephrol 1996;7:24032408.Google Scholar
25. Francino, MP. Antibiotics and the human gut microbiome: dysbioses and accumulation of resistances. Front Microbiol 2015;6:1543.Google ScholarPubMed
26. Chen, YE, Tsao, H. The skin microbiome: current perspectives and future challenges. J Am Acad Dermatol 2013;69:143155.CrossRefGoogle ScholarPubMed
27. Flowers, RH, Schwenzer, KJ, Kopel, RF, et al. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection. JAMA 1989;261:878883.CrossRefGoogle ScholarPubMed
28. Burnham, CA, Hogan, PG, Wallace, MA, et al. Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults. Antimicrob Agents Chemother 2016;60:73037312.CrossRefGoogle ScholarPubMed
29. Silvia Munoz-Price, L, Frencken, JF, Tarima, S, Bonten, M. Handling time dependent variables: antibiotics and antibiotic resistance. Clin Infect Dis 2016;62:15581563.CrossRefGoogle Scholar
Supplementary material: File

Pierce supplementary material

Figure S1

Download Pierce supplementary material(File)
File 12.7 MB