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

Kot­loff et al, Pedi­atrics. 2019 Jan

Abstract

BACKGROUND AND OBJECTIVES: Staphy­lo­coc­cus aureus (SA) is the sec­ond lead­ing cause of late-onset 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.

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.