A tale of two intensive care units (ICUs): Baseline Staphylococcus aureus colonization and mupirocin susceptibility in neonatal and pediatric patients requiring intensive care

Infect Control Hosp Epidemiol. 2023 Mar;44(3):447-452. doi: 10.1017/ice.2022.96. Epub 2022 Apr 22.

Abstract

Objective: To assess the incidence rate of S. aureus colonization at baseline along with the mupirocin susceptibility (or resistance) rate in patients in a neonatal intensive care unit (NICU) and a pediatric intensive care unit (PICU) in conjunction with the implementation of universal decolonization as the standard of care.

Design: Prospective cohort study.

Setting: Children's Hospital of Michigan (CHM) inpatient intensive care units (ICUs).

Participants: Newly admitted pediatric patients to the CHM NICU or PICU aged between 1 day and ≤21 years.

Interventions: Baseline and follow-up S. aureus screening cultures were obtained before patients underwent universal decolonization with mupirocin 2% antibiotic ointment (intranasal and umbilical) and chlorhexidine baths as standard of care to reduce CLABSI rates.

Results: Baseline S. aureus colonization rates of new admissions to the CHM NICU and PICU were high at 32% and 29%, respectively. Baseline mupirocin susceptibility to any S. aureus growth was 98.4%. All baseline culture isolates whether positive for MRSA or MSSA, with one exception, had minimum inhibitory concentrations (MICs) of ≤0.19 µg/mL. All follow-up study cultures after universal decolonization at 7 days or beyond with any S. aureus growth had mupirocin MICs of ≤0.125 µg/mL.

Conclusions: Baseline S. aureus colonization rates of new admissions to the CHM ICUs were high as was baseline mupirocin susceptibility. Follow-up cultures, albeit limited in number, did not detect increasing mupirocin MICs over 1 year, despite broad mupirocin exposure due to the implementation of universal decolonization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Resistance, Bacterial* / drug effects
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Neonatal*
  • Intensive Care Units, Pediatric*
  • Male
  • Microbial Sensitivity Tests
  • Mupirocin* / pharmacology
  • Mupirocin* / therapeutic use
  • Nasal Mucosa / drug effects
  • Nasal Mucosa / microbiology
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus* / drug effects
  • Umbilical Cord / drug effects
  • Umbilical Cord / microbiology
  • Young Adult

Substances

  • Mupirocin
  • Anti-Bacterial Agents