Staph transmission in NICU: low-cost treatment of parents shows promise

  • Milstone AM & al.
  • JAMA
  • 30 dic. 2019

  • de Emily Willingham, PhD
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • When parents of neonatal ICU (NICU) infants are treated with intranasal mupirocin and chlorhexidine-soaked cloths for Staphylococcus aureus colonization, infant colonization decreases.
  • Results of this preliminary trial require replication.

Why this matters

  • Editorial calls the study “bold and innovative” but warns that generalizability is not clear.

Key results

  • 40.0% (76/190) of infants had S aureus colonization at 90 days.
  • Of this group, 55.2% (42/76) had a strain identified in parent samples.
  • 33.7% (30/89) in the intervention group were S aureus colonized vs 45.5% (46/101) with placebo.
    • HR, 0.57 (95% CI, 0.31-0.88).
  • With the intervention, 14.6% (13/89) infants were colonized by a parent strain vs 28.7% (29/101) with placebo.
    • Risk difference at 8 weeks, −14.1% (95% CI, −30.8% to −3.9%).
    • HR, 0.43 (P=.03; meeting preplanned threshold for significance).
  • 1 infant in each group developed S aureus infection before colonization.
  • Skin reactions in parents: 4.8% intervention vs 6.2% placebo.

Study design

  • Double-blinded, placebo-controlled randomized trial, 2 tertiary NICUs.
  • Intervention: intranasal mupirocin and 2% chlorhexidine.
  • Placebo was intranasal petroleum jelly and nonmedicated soap cloths.
  • Funding: US Agency for Healthcare Research and Quality.

Limitations

  • Participating centers have comprehensive S aureus surveillance/decolonization programs, so generalizability is not clear.
  • No adjustment for degree of parent interaction.