Treating parents reduces colonization rate in neonates by half.


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Staphylococcus aureus colonization can lead to life-threatening infection in vulnerable newborns in neonatal intensive care units (NICUs). The S. aureus pathogen is responsible for the majority of central line-associated bloodstream infections, surgical-site infections, and late-onset sepsis in neonates.


Prevention efforts by NICU staff have centered on reducing neonates' exposure to S. aureus from health care personnel and the NICU's physical environment. However, parents of neonates may also be a source of S. aureus colonization and infection. A recent study in JAMA showed that treating parents colonized with S. aureus significantly reduced the likelihood of S. aureus colonization in their infants.


Researchers enrolled neonates at two NICUs in the Johns Hopkins Health System in Baltimore, Maryland. Eligible neonates were those without a prior positive culture for S. aureus who had at least one parent who screened positive for S. aureus. The infants were randomly assigned to an intervention group or a placebo group. Parents in the intervention group received 2% intranasal mupirocin ointment and 2% chlorhexidine gluconate cloths. Parents in the placebo group received 2% petrolatum intranasal ointment and nonmedicated soap cloths. Parents used their ointment twice daily and cleaned designated parts of their body with the cloths for five days. Surveillance swabs were used to check the infants for S. aureus colonization, collecting material for culture each week from several parts of the body.


In the intervention group, 13 of 89 neonates became colonized with the same strain of S. aureus as their parents within 90 days, for a transmission rate of 14.6%. In the placebo group, 29 of 101 neonates acquired the parental S. aureus strain, for a transmission rate of 28.7%.


The halving of the rate of colonization in the intervention group was statistically significant. However, the research team cautioned that further study is needed to prove that results of the intervention can be replicated and generalized since it took place in NICUs that already had comprehensive S. aureus surveillance and decolonization programs. An editorial accompanying the study noted that infant-parent bonding-including skin-to-skin contact-is a highly valued part of NICU care, suggesting an avenue for further research into the appropriate balance between family-centered care and infection control.-Joan Zolot, PA


Milstone AM, et alJAMA 2019 Dec 30 [Epub ahead of print]; Zachariah P, Saiman L. JAMA 2019 Dec 30 [Epub ahead of print].