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Treating parents with antibiotics, antiseptics may curb S. aureus transmission in NICU

January 06, 2020

By Marilynn Larkin

NEW YORK (Reuters Health) - Treating parents with intranasal mupirocin and topical chlorhexidine may reduce neonatal colonization with Staphylococcus aureus in the intensive care unit, a proof-of-concept study reveals.

"For most infants, exposure to S. aureus does not cause illness; but for some neonates, exposure to S. aureus is deadly," Dr. Aaron Milstone of Johns Hopkins University in Baltimore told Reuters Health by email. "The longer we can protect babies from acquiring S. aureus, the better. As clinicians, we encourage parents to visit with their child as often as possible, and we want to make this important bonding time as safe as possible."

Dr. Milstone and colleagues conducted a double-blind, randomized trial in two neonatal intensive care units (NICUs) involving infants whose parents were colonized with S. aureus. Parents were assigned to 2% intranasal mupirocin ointment and 2% chlorhexidine-impregnated cloths (active treatment; 117 parents) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo; 119 parents) for five days.

The primary end point was concordant S. aureus colonization within 90 days, defined as neonatal acquisition of an S. aureus strain that was the same as a parental strain at time of screening.

As reported in JAMA, 190 neonates were included in the analysis: 55% were male; 76%, singleton births; mean birth weight, 1,985 grams; 76% vaginal birth; and mean parent age at birth was 31.

Seventy-four (38.9%) acquired S. aureus colonization by 90 days, of whom 42 (56.8%) had a strain concordant with a parental baseline strain.

More specifically, 13 neonates (14.6%) in the intervention group and 29 (28.7%) in the placebo group acquired concordant S. aureus colonization (hazard ratio, 0.43).

Further, 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). One neonate in the intervention group (1.1%) and one in the control group (1.0%) developed an S. aureus infection before colonization.

Parental skin reactions were common, affecting 4.8% of the intervention group and 6.2% of the placebo group.

"This study should raise awareness and inspire clinicians to educate parents about their role in preventing infections, but should not cause parents to panic or be afraid to touch and bond with their infants," said Dr. Milstone, who is coleader of Project PROTect (, a program to guard hospitalized children from antibiotic-resistant bacteria and health care-associated infections. "Our next steps include improving the feasibility and generalizability of the intervention to prepare for a study to determine if treating parents will prevent S. aureus infections."

Dr. Lisa Saiman of Columbia University Irving Medical Center in New York City, coauthor of a related editorial, commented in an email to Reuters Health, "This proof-of-concept study is the first to systematically assess that S. aureus strains are shared by families and their babies hospitalized in the neonatal ICU and to provide evidence that the novel intervention of treating family members colonized with S. aureus can reduce the risk of babies becoming colonized with S. aureus. While colonization is a very important risk factor for infection, the majority of colonized infants do not develop infections."

"A much larger, multicenter study conducted in diverse populations will need to be done that both confirms the intervention successfully decolonizes family members and reduces S. aureus infections in their babies," she said.

SOURCE: and JAMA, online December 30, 2019.

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