Infections Among Infants in Intensive Care Units Are Lowered When Parents Are Decolonized

Parents of infants in neonatal intensive care units (NICUs) who are decolonized with a nasal antibiotic and a skin disinfectant are less likely to transmit Staphylococcus aureus (S. aureus) to their baby, according to a new AHRQ-funded study in JAMA. S. aureus is a leading cause of healthcare-associated infections among NICU babies and can threaten their survival and brain development. In their study of 208 babies, researchers at Johns Hopkins University School of Medicine found that decolonizing the parents of babies admitted to the NICU reduced S. aureus infections by half. Further research is needed to confirm the findings, researchers noted. Access the abstract.

2019 Dec 30. doi: 10.1001/jama.2019.20785. [Epub ahead of print]

Effect of Treating Parents Colonized With Staphylococcus aureus on Transmission to Neonates in the Intensive Care Unit: A Randomized Clinical Trial.

Milstone AM1,2,3, Voskertchian A1, Koontz DW1, Khamash DF1,4, Ross T5, Aucott SW6, Gilmore MM6, Cosgrove SE2,7, Carroll KC8, Colantuoni E9.

Author information

Abstract

IMPORTANCE:

Staphylococcus aureus is a leading cause of health care-associated infections in the neonatal intensive care unit (NICU). Parents may expose neonates to S aureus colonization, a well-established predisposing factor to invasive S aureus disease.

OBJECTIVE:

To test whether treating parents with intranasal mupirocin and topical chlorhexidine compared with placebo would reduce transmission of S aureus from parents to neonates.

DESIGN, SETTING, AND PARTICIPANTS:

Double-blinded randomized clinical trial in 2 tertiary NICUs in Baltimore, Maryland. Neonates (n = 236) with S aureus-colonized parent(s) were enrolled. The study period was November 7, 2014, through December 13, 2018.

INTERVENTIONS:

Parents were assigned to intranasal mupirocin and 2% chlorhexidine-impregnated cloths (active treatment, n = 117) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo, n = 119) for 5 days.

MAIN OUTCOMES AND MEASURES:

The primary end point was concordant S aureus colonization by 90 days, defined as neonatal acquisition of an S aureus strain that was the same strain as a parental strain at time of screening. Secondary outcomes included neonatal acquisition of any S aureus strain and neonatal S aureus infections.

RESULTS:

Among 236 randomized neonates, 208 were included in the analytic sample (55% male; 76% singleton births; mean birth weight, 1985 g [SD, 958 g]; 76% vaginal birth; mean parent age, 31 [SD, 7] years), of whom 18 were lost to follow-up. Among 190 neonates included in the analysis, 74 (38.9%) acquired S aureus colonization by 90 days, of which 42 (56.8%) had a strain concordant with a parental baseline strain. In the intervention and placebo groups, 13 of 89 neonates (14.6%) and 29 of 101 neonates (28.7%), respectively, acquired concordant S aureus colonization (risk difference, -14.1% [95% CI, -30.8% to -3.9%]; hazard ratio [HR], 0.43 [95.2% CI, 0.16 to 0.79]). A total of 28 of 89 neonates (31.4%) in the intervention group and 46 of 101 (45.5%) in the control group acquired any S aureus strain (HR, 0.57 [95% CI, 0.31 to 0.88]), and 1 neonate (1.1%) in the intervention group and 1 neonate (1.0%) in the control group developed an S aureus infection before colonization. Skin reactions in parents were common (4.8% intervention, 6.2% placebo).

CONCLUSIONS AND RELEVANCE:

In this preliminary trial of parents colonized with S aureus, treatment with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced neonatal colonization with an S aureus strain concordant with a parental baseline strain. However, further research is needed to replicate these findings and to assess their generalizability.