Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units

Document Type

Article

Publication Date

1-2019

Identifier

DOI: 10.1542/peds.2018-1565; PMCID: PMC6317770

Abstract

Video Abstract BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of late-onset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants.

Methods: Between April 2014 and May 2016, infantsintranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed.

Results: A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (P < .001). Twenty-one of 46 (45.7%) treated infants were persistently decolonized compared with 1 of 48 (2.1%) controls (P < .001).

Conclusions: Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized.

Trial registration: ClinicalTrials.gov NCT01827358.

Journal Title

Pediatrics

Volume

143

Issue

1

MeSH Keywords

Anti-Bacterial Agents; Female; Humans; Infant; Intensive Care Units, Neonatal; Male; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

Keywords

Anti-Bacterial Agents; Female; Humans; Infant; Intensive Care Units, Neonatal; Male; Mupirocin; Staphylococcal Infections; Staphylococcus aureus

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