Study: Decolonizing Parents Could Reduce Staph Risk for Newborns

The results of a new clinical trial indicate that treating parents with short-course intranasal mupirocin and topical chlorhexidine bathing can reduce the risk of transmitting Staphylococcus aureus (S aureus) to newborns in intensive care units (ICUs).

The randomized trial, which had its findings published in JAMA, included 190 neonates with parents colonized with S aureus. Parents were treated with intranasal mupirocin and chlorhexidine-impregnated cloths or placebo (petrolatum intranasal ointment and nonmedicated soap cloths).

The findings revealed that the use of the impregnated cloths "… significantly reduced the hazard of acquiring colonization with a parental S aureus strain."

The authors note that this trial suggests parents represent a "major reservoir" from which neonates acquire S aureus in the neonatal intensive care unit (NICU). Neonates are unique because they an immature microbiome upon NICU admission and rarely have preexisting S aureus colonization. Rather, neonates acquire S aureus colonization in the NICU from exposure to people and objects.

S aureus, the authors note, is a leading cause of healthcare-associated infections in the NICU. Parents with S aureus may expose neonates to S aureus colonization, which is a well-established predisposing factor to invasive S aureus disease. As the Centers for Disease Control and Prevention notes, staph infections can be serious or fatal and the risk of more serious staph infection is higher for patients in ICUs.

The randomized trial had a study period of November 2014 through December 2018. It was conducted by conducted by clinicians and researchers at Baltimore's Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health.

CDC List of Top 2019 Threats Prominently Features Infections

The Centers for Disease Control and Prevention (CDC) has issued its list of "Nine Health Threats That Made Headlines in 2019." Infections, infectious diseases and infection-related issues appear throughout the list.

They are as follows:

• Antibiotic and antimicrobial resistance. CDC highlights the significant threat of antibiotic-resistant bacteria and fungi, noting that they cause millions of infections and thousands of deaths annually in the United States. On average, someone contracts an antibiotic-resistant infection every 11 seconds, while someone dies every 15 minutes. Prevention efforts have helped reduce the number of deaths, but significant challenges remain.

• Measles. One statistic essentially tells the whole story of measles in 2019: This year, there were more U.S. measles cases than in any of the last 25 years. As of early December, CDC reported nearly 1,300 cases of measles in 31 states for 2019. This is the largest number of cases reported in the United States since 1992. A major contributing factor, as CDC notes: "Despite high nationwide coverage with the measles, mumps and rubella vaccine, there are still communities where low vaccination rates leave people vulnerable to these dangerous diseases."

• Immunization and vaccination. The threat of low immunization and vaccination rates receives its own section. CDC discusses the importance of pregnant women receiving the two vaccines recommended during pregnancy (influenza and whooping cough (pertussis)), the annual seasonal influenza vaccine and human papilloma virus (HPV) vaccine.

• Pregnancy-related deaths. CDC highlights a report that shows three in five pregnancy-related deaths could have been prevented. Infections is one of several causes of pregnancy-related deaths.

• HIV. "Progress in HIV prevention has stalled," CDC states, pointing to alarming statistics concerning diagnosing people living with HIV and the number of people who should be taking a daily HIV-prevention pill. A new initiative aims to reduce new HIV infections by 90% by 2030. 

• Ebola. Back in the spotlight because of the outbreak in the Democratic Republic of the Congo (DRC). The number of Ebola cases in DRC has surpassed 3,300, with more than 2,200 deaths. 

• Foodborne outbreaks. CDC states that in 2019, it investigated and resolved more than 75 outbreaks related to food or animal contact. 

Also on the list of threats: lung injuries linked to e-cigarettes/vaping and opioids.

Access the CDC's 2019 list.

Study: Ambulatory Care Clinics Prescribe Millions of Inappropriate Antibiotics

The results of a new study indicate that at least one out of every four antibiotics prescribed during ambulatory care visits were inappropriate.

The study, published in BMJ, examined data from the 2015 National Ambulatory Medical Care Survey. Researchers analyzed more than 28,000 sample visits representing close to a billion ambulatory care visits nationwide.

Their conclusions include the following:

• Antibiotics were prescribed during about 13% of ambulatory care visits in 2015.

• About 25% were for inappropriate indications (~32 million prescriptions).

• In addition, 18% lacked a documented indication (~24 million prescriptions).

• Combined, as many as 43% of prescriptions were potentially inappropriate.

• Factors contributing significantly to antibiotic prescribing without an indication were being an adult male, having at least one chronic disease, spending more time with the provider and seeing a non-primary care specialist.

• Prescriptions for sulfonamides and urinary anti-infectives were commonly associated with the absence of a documented infection.

In the study's conclusion, researchers state, "Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting and misinform antimicrobial stewardship efforts. … With 60% of antibiotic expenditure and up to 90% of antibiotic use originating in ambulatory care settings, more focus is needed to support well informed stewardship efforts beyond the hospital."