Mupirocin treatment effectively induced primary Staphylococcus aureus decolonization in 85% to 100% of infants in several neonatal ICUs throughout the United States, and the treatment was generally well tolerated, according to research published in Pediatrics.
“S. aureus is a leading cause of serious infection among infants in the NICU,” Karen L. Kotloff, MD, professor of pediatrics and division head of pediatric infectious diseases and tropical medicine at the University of Maryland School of Medicine, told Infectious Diseases in Children. “Colonization is a strong predictor of subsequent invasive infection. Our findings using a randomized controlled trial design indicate that topical mupirocin is safe and highly efficacious in eradicating S. aureus colonization and likely to reduce the risk of serious infections.”
Infants aged younger than 2 years treated in eight NICUs were screened for nasal S. aureus colonization. Those who were colonized and were eligible for the study (n = 155) were randomly assigned to receive 5 days of mupirocin to intranasal, periumbilical and perianal areas, or 5 days with no mupirocin.
Although mupirocin was generally well tolerated, Kotloff and colleagues observed a higher incidence of rash in treated infants (22%) compared with untreated infants (5%). The most frequently identified rashes included mild contact dermatitis or yeast infection centralized in the perianal area.
One infant had a moderate rash. Other adverse events included one instance of nasal mucosal swelling caused by reflux-induced vomiting and irritation from a nasal cannula. This condition began on day 7 and persisted for 3 weeks. Two infants developed severe apnea shortly after application. No severe pain or discomfort was observed.
Mupirocin successfully decolonized infants following the first application (93.9%) compared with no treatment (4.7%). According to the researchers, 45.7% of infants in the treatment group and 2.1% of infants in the control group had persistent decolonization 2 to 3 weeks later.
“Each NICU must weigh the benefits and limitations of implementing a mupirocin decolonization program,” Kotloff said. “In NICUs experiencing S. aureus infections, the benefit is likely to outweigh the risks, keeping in mind that many infants may need to receive mupirocin to prevent one clinical S. aureus infection. In NICUs where length of stay is prolonged, S. aureus recolonization may occur, and additional strategies may be needed to prevent subsequent clinical S. aureus infections. Perhaps the greatest risk of mupirocin use is induction of antimicrobial resistance, which must be monitored judiciously.” – by Katherine Bortz
Disclosure s: Kotloff reports receiving funds to conduct research on a rotavirus vaccine in Africa from Merck. Please see the study for all other authors’ relevant financial disclosures.