mupirocin and Infant--Premature--Diseases

The REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus), a large multicenter, randomized controlled trial in adult intensive care units (ICUs), found universal decolonization to be more effective than surveillance and isolation procedures with or without targeted decolonization for reducing rates of MRSA-positive clinical cultures. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention subsequently published protocols for implementing universal decolonization in ICUs based on the trial's methods. Caution should be exercised before widely adopting these procedures in neonatal intensive care units (NICUs), particularly strategies that involve bathing with chlorhexidine and mupirocin application due to the potential for adverse events in their unique patient population, especially preterm infants. Large multicenter trials in the NICUs are needed to evaluate the efficacy, short- and long-term safety, and cost effectiveness of these strategies prior to their widespread implementation.

Topics: Adult; Chlorhexidine; Humans; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections

The aim of this study was to investigate the genotypes of mupirocin-resistant methicillin-resistant Staphylococcus aureus (MR-MRSA) isolates in our neonatal intensive care unit (NICU) and their potential source.. One hundred one MRSA isolates obtained from 59 inborn and 42 outborn infants were identified and their antimicrobial susceptibility determined. Using pulse-field gel electrophoresis (PFGE) analysis, MR-MRSA isolates obtained from the neonatal patients in the NICU were compared with those from adult hospitalized in the same hospital and with community-associated MRSA (CA-MRSA) isolates recovered from different hospitals in Korea.. Overall, 47% of CA-MRSA and 79% of healthcare-associated MRSA isolates exhibited high-level mupirocin resistance (HLMR). Forty-five percent of the outborn infants were considered to have CA-MRSA at the time of admission to our NICU. Most HLMR-MRSA isolates from neonates were grouped into a single cluster by PFGE analysis, and which included CA-MRSA isolates with HLMR recovered from outborn infants who were already colonized when they were transferred to our NICU. They belonged to the same PFGE group as the community-genotype strains isolated from different hospitals in Korea. HLMR-MRSA isolates from adults patients were classified as different clones. None of the attending staff in the NICU were nasal carriers.. Community-genotype strains of MRSA with HLMR may be imported to our NICU through obstetrics clinics and contribute to MRSA colonization or infection in facilities with a high rate of admission of outborn infants.

Topics: Adult; Anti-Bacterial Agents; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Female; Genotype; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Male; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Republic of Korea; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Carrier State; Cohort Studies; Female; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Infection Control; Intensive Care Units, Neonatal; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Treatment Outcome

A pre-term, 7-week-old male infant presented with a recurrent pustular eruption involving his face and scalp with associated peripheral blood eosinophilia. Skin biopsy revealed spongiosis with numerous dermal and epidermal eosinophils without predominant follicular involvement. Immunohistology showed deposition of eosinophil granule major basic protein and eosinophil derived neurotoxin in the dermis and epidermis. He responded to conservative management. We discuss the differential diagnosis of neonatal eosinophilic pustular eruptions and suggest the term 'neonatal eosinophilic pustulosis' to best describe our case.

Topics: Anti-Bacterial Agents; Bandages; Biopsy; Eosinophil Major Basic Protein; Eosinophil-Derived Neurotoxin; Eosinophilia; Humans; Immunohistochemistry; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Mupirocin; Skin; Skin Diseases, Vesiculobullous; Sodium Chloride

Patient-to-patient transmission of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs) has been well described. We report the first documented outbreak of probable transmission of MRSA from a mother to 3 of her preterm quadruplet infants postnatally.. Routine surveillance of clinical microbiologic laboratory reports revealed an increased incidence of MRSA infections in our NICU, including 3 of 4 preterm quadruplets. Surveillance cultures of the anterior nares of all patients and the quadruplets' parents were performed to detect MRSA carriage. The isolates were typed by pulsed-field gel electrophoresis with the restriction endonuclease SmaI. Infection control strategies included mupirocin treatment and contact isolation precautions for infected/colonized infants.. Clinical cultures from infants A, C, and D and surveillance cultures of the quadruplets' mother and 2 additional unrelated infants grew the same clone of MRSA. The mother's only identified risk factors for MRSA acquisition were 2 prepartum hospitalizations related to the multiple gestation and previous treatment with antibiotics. All anterior nares cultures were negative for MRSA after mupirocin treatment.. Use of gowns and gloves by the family members of women with multiple gestations should be recommended to prevent transmission of potential pathogens in the NICU.

Topics: Adult; Amino Acid Sequence; Carrier State; Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Infection Control; Intensive Care Units, Neonatal; Methicillin Resistance; Mupirocin; Pregnancy; Pregnancy Complications; Quadruplets; Staphylococcal Infections; Staphylococcus aureus