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Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates

Journal of Perinatology volume 33, pages 313–318 (2013)Cite this article

Subjects

Abstract

Objective:

To examine the use of long-term prophylactic mupirocin as part of a comprehensive strategy in reducing Staphylococcus aureus colonization and infection in a neonatal intensive care unit (NICU).

Study Design:

Twice daily mupirocin was applied to all infants admitted to the NICU throughout hospitalization starting in 2004. S. aureus surveillance was implemented in 2008. The efficacy of these practices was evaluated with a retrospective review of infants admitted from 2004 to 2010 found to be colonized or infected with S. aureus.

Result:

During the study period, 66 of 6283 NICU infants had a S. aureus infection with 67% methicillin resistance. There were three distinctive S. aureus outbreaks, the first being a methicillin-resistant strain July 2004. After implementation of daily mupirocin, the outbreak was eradicated and the rate of S. aureus infection significantly decreased (1.82 to 0.40/1000 patient-days-at-risk, P=0.0049). Mupirocin was discontinued March 2005 followed by a methicillin-sensitive S. aureus outbreak November 2005. In December 2005, mupirocin was reinstituted and has continued to present day, again significantly reducing S. aureus infections (1.42 to 0.33/1000 patient-days-at-risk, P<0.0001) with zero isolates resistant to mupirocin. In the pre-mupirocin period, S. aureus colonization was upwards of 60% now with rates typically <5%. S. aureus colonization strongly predicted later invasive infection (P<0.0001).

Conclusion:

Although controversial, prophylactic mupirocin in all NICU infants has acted as a barrier to colonization and markedly decreased S. aureus infection rates over a 5-year period.

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References

  1. Huang Y-C, Chou Y-H, Su L-H, Lien R-I, Lin T-Y . Methicillin-Resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics 2006; 118 (2): 469–474.

    Article  PubMed  Google Scholar 

  2. Chuang Y-Y, Huang Y-C, Lee C-Y, Lin T-Y, Lien R-I, Chou Y-H . Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodes. Acta Paediatr 2004; 93: 786–790.

    Article  CAS  PubMed  Google Scholar 

  3. Nambiar S, Herwaldt LA, Singh N . Outbreak of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med 2003; 4: 220–226.

    Article  PubMed  Google Scholar 

  4. Saiman L, Cronquist A, Wu F, Zhou J, Rubenstein D, Eisner W et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003; 24 (5): 317–321.

    Article  PubMed  Google Scholar 

  5. Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ . Nosocomial infections among neonates in high-risk nurseries in United States. Pediatrics 1996; 98: 357–361.

    CAS  PubMed  Google Scholar 

  6. Lessa FC, Edwards JR, Fridkin SK, Tenover FC, Horan TC, Gorwitz RJ . Trends in Incidence of Late-Onset Methicillin-Resistant Staphylococcus aureus Infection in Neonatal Intensive Care Units. Pediatr Infect Dis J 2009; 28 (7): 577–581.

    Article  PubMed  Google Scholar 

  7. Pan A, Carnevale G, Catenazzi P, Colombini P, Crema L, Dolcetti L et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA ‘search and isolate’ strategy in a hospital in Italy with hyperendemic MRSA. Infect Control Hosp Epidemiol 2005; 26 (2): 127–133.

    Article  PubMed  Google Scholar 

  8. Gregory ML, Eichenwald EC, Puopolo KM . Seven-year experience with a surveillance program to reduce methicillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit. Pediatrics 2009; 123: e790–e796.

    Article  PubMed  Google Scholar 

  9. Muller A, Talon D, Potier A, Belle E, Cappelier G, Bertrand X . Use of intranasal mupirocin to prevent methicillin-resistant Staphylococcus aureus infection in intensive care units. Crit Care 2005; 9 (3): R246–R250.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mody L, Kauffman CA, McNeil SA, Galecki AT, Bradley SF . Mupirocin-based decolonization of Staphylococcus aureus carriers in residents of 2 long-term care facilities: A randomized, double-blind, placebo-controlled trial. Clin Infect Dis 2003; 37 (11): 1467–1474.

    Article  PubMed  Google Scholar 

  11. Stark AR . Committee on Fetus and Newborn, Levels of Neonatal Care. Pediatrics 2004; 114 (5): 1341–1347.

    Article  PubMed  Google Scholar 

  12. Institute for Healthcare Improvement. Prevention of central line-associated bloodstream infections. Accessed 29 December 2011 from www.ihi.org.

  13. Popovich K, Hota B, Rice T, Aroutcheva A, Weinstein RA . Phenotypic prediction rule for community-associated methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2007; 45: 2293–2295.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Horan TC, Andrus M, Dudeck MA . CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309–332.

    Article  PubMed  Google Scholar 

  15. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM . CDC definitions for nosocomial infections. Am J Infect Control 1988; 16: 128–140.

    Article  CAS  PubMed  Google Scholar 

  16. Hitomi S, Kubota M, Mori N, Baba S, Yano H, Okuzumi K et al. Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by unselective use of nasal mupirocin ointment. J Hosp Infection 2000; 46 (2): 123–129.

    Article  CAS  Google Scholar 

  17. Lepelletier D, Corvec S, Caillon J, Reynaud A, Roze J-C, Gras-Leguen C . Eradication of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: Which measures for which success? Am J Infect Control 2009; 37: 195–200.

    Article  PubMed  Google Scholar 

  18. Haddad W, Sobayo EI, Basit OBA, Rotimi VO . Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J of Hosp Infect 1993; 23: 211–221.

    Article  CAS  Google Scholar 

  19. Lally RT, Lanz E, Schrock CG . Rapid control of an outbreak of Staphylococcus aureus on a neonatal intensive care deparement using standard infection control practices and nasal mupirocin. Am J of Infect Control 2004; 32 (1): 44–47.

    Article  Google Scholar 

  20. Graham PL, Morel A-S, Zhou J, Wu F, Della-Latta P, Rubenstein D et al. Epidemiology of Methicillin-Susceptible Staphylococcus aureus in the Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2002; 23 (11): 677–682.

    Article  PubMed  Google Scholar 

  21. Song X, Cheung S, Klontz K, Short B, Campos J, Singh N . A stepwise approach to control an outbreak and ongoing transmission of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Infect Control 2010; 38: 607–611.

    Article  PubMed  Google Scholar 

  22. Miller MA, Dascal A, Portnoy J, Mendelson J . Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996; 17: 811–813.

    Article  CAS  PubMed  Google Scholar 

  23. Perez-Roth E, Claverie-Martin F, Batista N, Moreno A, Mendez-Alvarez S . Mupirocin resistance in methicillin-resistant Staphylococcus aureus clinical isolates in a Spanish hospital: co-application of multiplex PCR assay and conventional microbiology methods. Diagn Microbiol Infect Dis 2002; 43: 123–128.

    Article  CAS  PubMed  Google Scholar 

  24. Fawley WN, Parnell P, Hall J, Wilcox MH . Surveillance for mupirocin resistance following introduction of routine peri-operative prophylaxis with nasal mupirocin. J Hosp Infect 2006; 26 (3): 327–332.

    Article  Google Scholar 

  25. Mayall B, Martin R, Keenan AM, Irving L, Leeson P, Lamb K . Blanket use of intarnasal mupirocin for outbreak control and long-term prophylaxis of endemic methicillin-resistant Staphylococcus aureus in an open ward. J Hosp Infect 1996; 32: 257–266.

    Article  CAS  PubMed  Google Scholar 

  26. Patel JB, Gorwitz RJ, Jernigan JA . Mupirocin Resistance. Clin Infect Dis 2009; 49 (6): 935–941.

    Article  CAS  PubMed  Google Scholar 

  27. Sax H, Posfay-Barbe K, Harbarth S, Francois P, Touveneau S, Pessoa-Silva CL et al. Control of a cluster of community-associated, methicillin-resistant Staphylococcus aureus in neonatology. J Hosp Infect 2006; 63 (1): 93–100.

    Article  CAS  PubMed  Google Scholar 

  28. Behari P, Englund J, Alcasid G, Garcia-Houchins S, Weber S . Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk. Infect Control Hosp Epidemiol 2004; 25 (9): 778–780.

    Article  PubMed  Google Scholar 

  29. Singh K, Gavin PJ, Vescio T, Thomson RB, Deddish RB, Fisher A et al. Microbiologic surveillance using nasal cultures alone is sufficient for detection of methicillin-resistant Staphylococcus aureus isolates in neonates. J Clin Microbiol 2003; 41 (6): 2755–2757.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rosenthal A, White D, Churilla S, Brodie S, Katz K . Optimal surveillance culture sites for detection of methicillin-resistant Staphylococcus aureus in newborns. J of Clin Micro 2006; 44 (11): 4234–4236.

    Article  CAS  Google Scholar 

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Acknowledgements

We wish to thank Dr Mike Lustik for providing statistical support for this project. We would also like to thank Dr Taylor Sawyer and Dr Thornton Mu for their thoughtful revisions to this manuscript.

Disclaimer

‘The views expressed in this abstract/manuscript are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.’

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Authors and Affiliations

  1. Department of Pediatrics, Neonatology, Tripler Army Medical Center, Honolulu, HI, USA

    H M Delaney

  2. University of Hawaii Undergraduate School, Honolulu, HI, USA

    E Wang

  3. Department of Pediatrics, Infectious Disease, Kapi’olani Medical Center for Women and Children, Honolulu, HI, USA

    M Melish

Authors
  1. H M Delaney
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  2. E Wang
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Correspondence to H M Delaney.

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Delaney, H., Wang, E. & Melish, M. Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates. J Perinatol 33, 313–318 (2013). https://doi.org/10.1038/jp.2012.102

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