1741. Effect of  Mupirocin Prophylaxis on MRSA Transmission and Invasive Staphylococcal Infections in a Neonatal Intensive Care Unit
Session: Poster Abstract Session: Outbreaks of Bad Bugs and Prevention in Children
Saturday, October 10, 2015
Room: Poster Hall
  • Mupirocin FINAL FINAL.pdf (126.2 kB)
  • Background: Staphylococcus aureus (SA) is an important healthcare-associated (HA) pathogen in NICUs. Colonized infants are at risk for developing invasive infections. Limited data are available about the utility of topical mupirocin in preventing SA transmission and infection in this setting. A 101-bed NICU with a comprehensive strategy for preventing methicillin-resistant S. aureus (MRSA) transmission (weekly surveillance cultures, cohorting, contact precautions, topical mupirocin and chlorhexidine bathing for colonized infants) implemented universal, monthly mupirocin prophylaxis (MP) as an incremental prevention strategy. HA-MRSA transmissions and rates of invasive SA infections before and after implementation were assessed.

    Methods: HA- MRSA transmissions were identified through review of clinical cultures and weekly surveillance cultures 8/2009 to 4/2015. Invasive SA infections included patients with MSSA or MRSA isolated from blood or CSF after admission. Starting in 12/ 2013, all NICU infants without a medical contraindication received monthly applications of MP (anterior nares and perirectal area twice daily for 5 days). Infants could be treated more than once.  Rate of infections and transmission pre- and post- MP was evaluated by interrupted time-series analysis (n=174,443 patient-days). Temporal changes in both rates were examined using mixed-effects segmented linear regression.

    Results: The rate of HA-associated MRSA transmissions significantly decreased from 23.1 events (95% CI, 11.8-41.2) per 10,000 patient-days to 13.2 events (95% 6.9-26.0) per 10,000 patient days (p=0.018), representing a 43% reduction, after the monthly MP was initiated. The rate of invasive infection significantly decreased from 3.0 infections (95% CI 1.8-7.2) per 10,000 patient-days to 0.8 infections (95% CI 0.3-1.5) per 10,000 patient days (p=0.032), representing a 73% reduction. Two of 4 infants who developed invasive infection in the post-intervention period had received ≥1 MP application.

    Conclusion: Monthly MP was associated with decreased rates of MRSA transmission and invasive staphylococcal infections. This strategy deserves further evaluation as part of a comprehensive strategy to eliminate HAIs in NICUs.

    Elizabeth Ristagno, MD1, Kristina Bryant, MD, FPIDS1, Lynette Boland, RN, BSN2, Claudia Espinosa, MD, MSc1 and John Myers, PhD3, (1)Pediatrics, University of Louisville, Louisville, KY, (2)Kosair Children's Hospital, Louisville, KY, (3)University of Louisville, Louisville, KY


    E. Ristagno, None

    K. Bryant, Pfizer: Investigator , Research support

    L. Boland, None

    C. Espinosa, None

    J. Myers, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.