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

Abstract

BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of lateonset 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, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, 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. abstract NIH

SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches to Staphylococcus aureus disease prevention

“…28,29 Some prospective data show success with routine surveillance of new admissions followed by decolonization with nasal mupirocin to reduce invasive disease. 30 Whether environmental contamination contributes to S. aureus acquisition in the NICU remains unclear. No data exist, in any age group, to suggest that environmental culturing provides useful information to prevent S. aureus transmission and infections.…”

“…2,21,[32][33][34] Infants colonized with MSSA are also at increased risk of infection. 30,31 In some populations, eradicating S. aureus colonization, via decolonization, can reduce the risk of infection. 21,28,30,35 Both targeted and universal decolonization strategies have been employed in NICUs, but data are more limited for universal decolonization.…”

“…30,31 In some populations, eradicating S. aureus colonization, via decolonization, can reduce the risk of infection. 21,28,30,35 Both targeted and universal decolonization strategies have been employed in NICUs, but data are more limited for universal decolonization. Data showing efficacy and safety of S. aureus decolonization to reduce infection risk are primarily available from observational studies and a recent randomized trial that was not powered to detect a reduction in S. aureus infections.…”

“…Data showing efficacy and safety of S. aureus decolonization to reduce infection risk are primarily available from observational studies and a recent randomized trial that was not powered to detect a reduction in S. aureus infections. 6,29,30,[35][36][37] Even though decolonization has included treatment with topical antibiotics, topical antiseptics, and rarely, systemic antimicrobials, intranasal mupirocin alone is most commonly used. Intranasal mupirocin is not approved by the US Food and Drug Administration (FDA) for this indication in neonates, yet numerous studies reporting the use of mupirocin for S. aureus decolonization have not identified any clinically relevant adverse effects.…”

A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial

“…Moreover, oral mupirocin is rapidly metabolised, thus lowering the risk of causing adverse effects in the nursing baby 17. A clinical trial showed that mupirocin was generally well tolerated in infants 23…”