title: 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.
abstract: The REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus), a large multicenter, randomized controlled trial in adult intensive care units (ICUs), found universal decolonization to be more effective than surveillance and isolation procedures with or without targeted decolonization for reducing rates of MRSA-positive clinical cultures. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention subsequently published protocols for implementing universal decolonization in ICUs based on the trial's methods. Caution should be exercised before widely adopting these procedures in neonatal intensive care units (NICUs), particularly strategies that involve bathing with chlorhexidine and mupirocin application due to the potential for adverse events in their unique patient population, especially preterm infants. Large multicenter trials in the NICUs are needed to evaluate the efficacy, short- and long-term safety, and cost effectiveness of these strategies prior to their widespread implementation.
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: M U
authors.initials: MU
authors.lastname: Nelson
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bizzarro
authors.affiliation: 1] Division of Infectious Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA [2] Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA [3] Department of Infection Control, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Dembry
authors.affiliation: 1] Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA [2] Department of Infection Control, Yale-New Haven Hospital, New Haven, CT, USA [3] Division of Infectious Disease, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Baltimore
authors.affiliation: 1] Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA [2] Department of Pathology, Yale University School of Medicine, New Haven, CT, USA [3] Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D002710:Chlorhexidine / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development*; D016712:Mupirocin / Q000009:adverse effects; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000517:prevention & control*
chemical_list: D016712:Mupirocin; D002710:Chlorhexidine