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

Active Surveillance Cultures and Targeted Decolonization Are Associated with Reduced Methicillin-Susceptible <b><i>Staphylococcus aureus</i></b> Infections in VLBW Infants

“…A high prevalence of mupirocin-resistant S. aureus strains was reported after the widespread use of mupirocin in adult ICU [18,19] but not in neonates so far [13,14]. In line with these reports, we did not detect mupirocin-resistant MSSA strains during the study period.…”

“…Hence, the higher prevalence and associated burden of MSSA infections versus MRSA infections suggests a potential clinical benefit for the establishment of an active surveillance protocol of the MSSA colonization of VLBWI. To date, recommendations for the surveillance of MSSA colonization in neonates are less defined, and the data concerning efficacy and safety are insufficient [18]. …”

New Threats from an Old Foe: Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> Infections in Neonates

“…However, in other centers, up to 50% of neonates may be persistently colonized or recolonized by MRSA, and a fraction of patients may still develop a subsequent infection despite decolonization [11, 63, 69]. Notably, the current MRSA decolonization protocol largely stems from guidelines for adults [65], and robust evidence regarding its extrapolation to neonates is scarce [70]. Currently, the following questions on MRSA surveillance and decolonization in neonates are yet to be addressed: (1) the implementation of universal versus targeted active surveillance cultures in neonates at high risk for MRSA colonization and infection [10, 64], (2) the definition of optimum surveillance time points to better identify colonized neonates [10, 64], and (3) the benefit of screening extranasal sites for early identification of colonized infants [10, 16, 64].…”

“…Moreover, the importance of new screening methods, such as polymerase chain reaction and whole-genome sequencing, needs to be defined [6, 7, 10, 16, 64]. Since MRSA resistant to mupirocin and antiseptics have been reported [18, 44, 71], the efficacy of nasal mupirocin application in primary and persistent MRSA decolonization warrants verification [10, 70, 72], Finally, potential adverse effects of antiseptic baths, such as skin irritation and toxicity [73], as well as nonantimicrobial strategies like maternal skin-to-skin contact for MRSA decolonization remain subjects of discussion [74]. …”

Success of Targeted Strategies to Reduce Methicillin-Susceptible Staphylococcus aureus Infections in the Neonatal Intensive Care Unit

“…Such a study design is likely to be embraced by the neonatology community. 10 In addition, a larger future study could more fully assess the durability of decolonization, assess whether infected infants acquire new S. aureus strains or become infected with their colonizing strains, determine optimal Affiliations: 1. Columbia University Medical Center, New York, New York; 2.…”