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Bacterial Infections in Neonates Following Mupirocin-Based MRSA Decolonization: A Multicenter Cohort Study

Published online by Cambridge University Press:  05 June 2017

Rebecca Pierce ,
Kristina Bryant ,
Alexis Elward ,
Justin Lessler  and
Aaron M. Milstone
Rebecca Pierce*
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Kristina Bryant
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
Alexis Elward
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
Justin Lessler
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Aaron M. Milstone*
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Address correspondence to Rebecca Pierce, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E6008, Baltimore, MD 21287 (rpierc13@jhu.edu) or Aaron Milstone, Johns Hopkins Department of Pediatric Infectious Diseases, 200 North Wolfe St., Rubenstein 3141, Baltimore, MD 21287 (amilsto1@jhmi.edu).
Address correspondence to Rebecca Pierce, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E6008, Baltimore, MD 21287 (rpierc13@jhu.edu) or Aaron Milstone, Johns Hopkins Department of Pediatric Infectious Diseases, 200 North Wolfe St., Rubenstein 3141, Baltimore, MD 21287 (amilsto1@jhmi.edu).
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Abstract

OBJECTIVE

To characterize the risk of infection after MRSA decolonization with intranasal mupirocin.

DESIGN

Multicenter, retrospective cohort study.

SETTING

Tertiary care neonatal intensive care units (NICUs) from 3 urban hospitals in the United States ranging in size from 45 to 100 beds.

METHODS

MRSA-colonized neonates were identified from NICU admissions occurring from January 2007 to December 2014, during which a targeted decolonization strategy was used for MRSA control. In 2 time-to-event analyses, MRSA-colonized neonates were observed from the date of the first MRSA-positive surveillance screen until (1) the first occurrence of novel gram-positive cocci in sterile culture or discharge or (2) the first occurrence of novel gram-negative bacilli in sterile culture or discharge. Mupirocin exposure was treated as time varying.

RESULTS

A total of 522 MRSA-colonized neonates were identified from 16,144 neonates admitted to site NICUs. Of the MRSA-colonized neonates, 384 (74%) received mupirocin. Average time from positive culture to mupirocin treatment was 3.5 days (standard deviation, 7.2 days). The adjusted hazard of gram-positive cocci infection was 64% lower among mupirocin-exposed versus mupirocin-unexposed neonates (hazard ratio, 0.36; 95% confidence interval [CI], 0.17–0.76), whereas the adjusted hazard ratio of gram-negative bacilli infection comparing mupirocin-exposed and -unexposed neonates was 1.05 (95% CI, 0.42–2.62).

CONCLUSIONS

In this multicentered cohort of MRSA-colonized neonates, mupirocin-based decolonization treatment appeared to decrease the risk of infection with select gram-positive organisms as intended, and the treatment was not significantly associated with risk of subsequent infections with organisms not covered by mupirocin’s spectrum of activity.

Infect Control Hosp Epidemiol 2017;38:930–936

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 930 - 936
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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