Effect of mupirocin decolonization on subsequent methicillin-resistant Staphylococcus aureus infection in infants in neonatal intensive care units.
OBJECTIVE
To evaluate whether topical mupirocin treatment can effectively decolonize methicillin-resistant Staphylococcus aureus (MRSA) carriage and reduce subsequent MRSA infection in neonates.


METHODS
During a 1-year period, the infants admitted to our neonatal intensive care units (NICUs)-1 and NICU-2 were included, and specimens from the nares and umbilicus were obtained within 24 hours, and specimen collection was repeated weekly for 2 weeks. Mupirocin was administered for 5 days to the infants with MRSA colonization in NICU-1 during the first half of the year and then switched to those in NICU-2 during the second half of the year.


RESULTS
A total of 525 infants were recruited: 257 infants in the treatment group and 268 in the control group. MRSA colonization was detected in 130 infants (25%) during NICU stay, which is a similar rate in both groups. Twenty-two (4.2%) episodes of MRSA infection were identified. The rate of MRSA infection was significantly higher in infants with prior colonization than in those without (10.2% vs. 2.3%, P<0.001). Among the infants with prior colonization, the rate of MRSA infection in the treatment group was significantly lower than that in the control group (3.2% vs. 16%, P=0.014), and the rate in the treatment group was comparable to that in those without colonization (P=0.7804). Of the 15 infants with both clinical and colonizing isolates, indistinguishable strains between the paired isolates from the same infant by molecular methods were identified in 14 infants (93%).


CONCLUSIONS
Administering mupirocin topical therapy to MRSA-colonized infants in NICUs might reduce subsequent MRSA infections during hospitalization in these infants. A large-scale study should be conducted.
From the *Division of Pediatric Infectious Diseases and †Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan; and ‡School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
Yhu-Chering
YC
Huang
Rey-In
RI
Lien
Tzou-Yien
TY
Lin
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State / Q000382:microbiology / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D016712:Mupirocin / Q000494:pharmacology*; D016017:Odds Ratio; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D016712:Mupirocin