Decolonization reduces parent-to-child S. aureus transmission in NICU

Aaron M. Milstone

Parental application of nasal antibiotic ointment and use of antiseptic wipes may significantly reduce parent-to-infant transmission of Staphylococcus aureus in the NICU, according to study results published in JAMA.

“Parents are an important reservoir from which neonates can acquire S. aureus,” Aaron M. Milstone, MD, MHS, professor of pediatric infectious diseases and epidemiology and associate hospital epidemiologist at Johns Hopkins Medicine, told Healio. “Although some questions remain before the studied intervention can be widely applied, this study should raise awareness. Parents should be encouraged to wash their hands, just as health care workers do, before touching their child in the neonatal intensive care unit setting where neonates are at high risk of infection.”

Milstone and colleagues examined 190 newborn babies admitted to two NICUs with at least one parent who tested positive for S. aureus at the time of entry. The parents of 89 of the newborns used chlorhexidine wipes on designated areas of skin and self-administered nasal mupirocin, which has been previously shown to decolonize NICU patients with S. aureus. The remaining 101 parents were given a placebo of petroleum jelly and non-antiseptic wipes.

Among the total infants studied, 22.1% acquired S. aureus that matched bacteria recovered from their mother, father or both parents. Of the 89 babies with parents who self-administered antiseptic wipes and the nasal antibiotic, 15% had parentally acquired S. aureus compared with 29% of the 101 babies in the control group.

Cleansing before skin-to skin contact between parents and infants also has been shown to reduce incidence of S. aureus.

Milstone noted that the “very aggressive S. aureus control programs” used in the study may not be generalizable to other settings, and that one of the study’s major limitations is that it covered transmission — but not overall infection — of S. aureus.

“Larger studies are needed to determine whether this approach will reduce infection, but colonization is a well-known predisposing factor to infection, so we hypothesize that this intervention will reduce infections,” Milstone said. – by Eamon Dreisbach

Reference:

Milstone AM, et al. JAMA. 2019;doi:10.1001/jama.2019.20785.

Disclosures: Milstone reports receiving grants from the CDC, NIH and Sage Products Inc. and receiving personal fees from Becton Dickinson. Please see the study for all other authors’ relevant financial disclosures.