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父母金黄色葡萄球菌定植对重症监护病房新生儿感染的影响
作者:小柯机器人 发布时间:2020/1/3 18:24:22

近日,美国约翰霍普金斯大学医学院的Aaron M. Milstone联合彭博公共卫生学院Elizabeth Colantuoni研究团队,共同探明了父母金黄色葡萄球菌定植对重症监护病房新生儿感染的影响。2019年12月30日,国际知名学术期刊《美国医学会杂志》发表了这一成果。

金黄色葡萄球菌是新生儿重症监护病房(NICU)医疗相关感染的主因。目前已公认金黄色葡萄球菌定植的父母可能导致新生儿遭受侵袭性金黄色葡萄球菌感染。

为减少金黄色葡萄球菌从父母传染至新生儿,研究组在马里兰州巴尔的摩的两个三级NICU中进行了一项双盲随机临床试验。从2014年11月7日至2018年12月13日,研究组共招募了236名新生儿,其父母均有金黄色葡萄球菌定植。按1:1将父母们随机分组,其中117对父母接受鼻内莫匹罗星和2%氯己定浸渍布治疗(干预组),119对父母接受鼻内凡士林软膏和非医用肥皂布治疗(安慰剂组),两组均治疗5天。

236例新生儿中,有208例被纳入样本分析,其中55%为男婴,76%为单胎,平均出生体重为1985g,76%经阴道分娩,父母的平均年龄为31岁,最终有18例新生儿失访。在190例新生儿中,74名(38.9%)在90天内获得金黄色葡萄球菌定植,其中42名(56.8%)与父母菌株一致。

干预组89名新生儿中有13名(14.6%)获得与父母菌株一致的金黄色葡萄球菌定植,而安慰剂组101名新生儿中有29名(28.7%),风险比为0.43。干预组中共有28名新生儿(31.4%)获得金黄色葡萄球菌定植,安慰剂组有46名(45.5%),风险比为0.57。两组中各有1例新生儿在定植前就发生金黄色葡萄球菌感染。父母中的皮肤反应较为常见,其中干预组发生率为4.8%,对照组为6.2%。

研究结果表明,金黄色葡萄球菌定植的父母,采用鼻内莫匹罗星和氯己定浸渍布治疗,与安慰剂相比,显著降低了新生儿源于父母的金黄色葡萄球菌的定植率。

附:英文原文

Title: Effect of Treating Parents Colonized With Staphylococcus aureus on Transmission to Neonates in the Intensive Care Unit: A Randomized Clinical Trial

Author: Aaron M. Milstone, Annie Voskertchian, Danielle W. Koontz, Dina F. Khamash, Tracy Ross, Susan W. Aucott, Maureen M. Gilmore, Sara E. Cosgrove, Karen C. Carroll, Elizabeth Colantuoni

Issue&Volume: December 30, 2019

Abstract: Importance  Staphylococcus aureus is a leading cause of health care–associated infections in the neonatal intensive care unit (NICU). Parents may expose neonates to S aureus colonization, a well-established predisposing factor to invasive S aureus disease.

Objective  To test whether treating parents with intranasal mupirocin and topical chlorhexidine compared with placebo would reduce transmission of S aureus from parents to neonates.

Design, Setting, and Participants  Double-blinded randomized clinical trial in 2 tertiary NICUs in Baltimore, Maryland. Neonates (n = 236) with S aureus–colonized parent(s) were enrolled. The study period was November 7, 2014, through December 13, 2018.

Interventions  Parents were assigned to intranasal mupirocin and 2% chlorhexidine–impregnated cloths (active treatment, n = 117) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo, n = 119) for 5 days.

Main Outcomes and Measures  The primary end point was concordant S aureus colonization by 90 days, defined as neonatal acquisition of an S aureus strain that was the same strain as a parental strain at time of screening. Secondary outcomes included neonatal acquisition of any S aureus strain and neonatal S aureus infections.

Results  Among 236 randomized neonates, 208 were included in the analytic sample (55% male; 76% singleton births; mean birth weight, 1985 g [SD, 958 g]; 76% vaginal birth; mean parent age, 31 [SD, 7] years), of whom 18 were lost to follow-up. Among 190 neonates included in the analysis, 74 (38.9%) acquired S aureus colonization by 90 days, of which 42 (56.8%) had a strain concordant with a parental baseline strain. In the intervention and placebo groups, 13 of 89 neonates (14.6%) and 29 of 101 neonates (28.7%), respectively, acquired concordant S aureus colonization (risk difference, –14.1% [95% CI, –30.8% to –3.9%]; hazard ratio [HR], 0.43 [95.2% CI, 0.16 to 0.79]). A total of 28 of 89 neonates (31.4%) in the intervention group and 46 of 101 (45.5%) in the control group acquired any S aureus strain (HR, 0.57 [95% CI, 0.31 to 0.88]), and 1 neonate (1.1%) in the intervention group and 1 neonate (1.0%) in the control group developed an S aureus infection before colonization. Skin reactions in parents were common (4.8% intervention, 6.2% placebo).

Conclusions and Relevance  In this preliminary trial of parents colonized with S aureus, treatment with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced neonatal colonization with an S aureus strain concordant with a parental baseline strain. However, further research is needed to replicate these findings and to assess their generalizability.

DOI: 10.1001/jama.2019.20785

Source: https://jamanetwork.com/journals/jama/fullarticle/2758295

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex