News Scan for Dec 28, 2018

Staph decolonization in the NICU
Saudi MERS overview

Randomized trial supports use of mupirocin in NICU infants

The results of a phase 2 randomized clinical trial indicate that application of the topical antibiotic mupirocin to multiple body sites was safe and efficacious in eradicating Staphylococcus aureus from infants in the neonatal intensive care unit (NICU). The findings were published in Pediatrics.

In the multicenter study, infants under the age of 24 months in the NICU at eight US hospitals were screened for nasal S aureus colonization, and colonized infants who met eligibility criteria were randomly assigned 1:1 to receive either 5 days of mupirocin applied to the intranasal, periumbilical, or perianal areas or no mupirocin. Because S aureus is the second-leading cause of late-onset sepsis among infants in the NICU and colonization of the nasal mucosa or skin frequently precedes invasive infection, mupirocin application and other decolonization strategies have been explored as ways to prevent infection. However, data supporting these strategies has been limited.

From April 2014 to May 2016, 1,140 infants tested positive for S aureus, and 155 were randomly assigned. The investigators assessed safety and the effect of mupirocin treatment on primary decolonization (8 days) and persistent decolonization (22 days). Mupirocin was generally well-tolerated, though mild rashes were observed significantly more often in the infants who were treated. Primary decolonization occurred in 62 of 66 (93.9%) treated patients compared with 3 of 64 (4.7%) untreated infants, yielding on overall efficacy of 95%.  By day 22, 21 of 46 (45.7%) treated infants remained decolonized, compared with 1 of 48 (2.1%) of the untreated infants.

The authors of the study say the finding that more than 50% of the mupirocin-treated infants became recolonized after 22 days suggests supplemental strategies may be needed for infants undergoing lengthy hospitalization, including decolonization of family members and caregivers.
Dec 26 Pediatrics abstract


WHO adds details about recent Saudi MERS cases

The World Health Organization (WHO) today filled in details about eight MERS-CoV cases, two of them fatal, that Saudi Arabia reported between Oct 31 and Nov 30.

All are adults ages 29 to 75, and all but one of the patients are men. Five people are from Riyadh region and three are from Qassim, both of which are in the central part of the country.

No camel contact or exposure to camel products were reported for any of the patients, and two people contracted their Middle East respiratory syndrome coronavirus (MERS-CoV) from other sick patients. None of the people are healthcare workers. All were hospitalized, and five had underlying medical conditions.

Fatalities include a 53-year-old man from Riyadh and a 75-year-old man from Qassim.

The WHO said the latest cases don't change its current risk assessment and that the developments lift the global total to 2,274 with at least 806 related deaths. Most are from Saudi Arabia.
Dec 28 WHO update

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