Decreasing Neonatal Staphylococcus aureus Disease Through Parental Intervention

描述（由申请人提供）：在美国，每年有近500，000名婴儿早产。早产是导致儿童长期神经功能障碍的主要原因，每年的费用超过260亿美元。早产儿在新生儿重症监护室（NICU）接受护理，超过33，000名早产儿发生了医疗保健相关感染（HAI）。据估计，HAI每年将导致280 - 450亿美元的医疗保健成本。除了HAI的短期成本外，新生儿感染还会导致破坏性的神经功能障碍 和增长成果不佳。金黄色葡萄球菌(S.金黄色葡萄球菌）是引起新生儿HAI的第二常见病原体。在57，000名极低出生体重儿中，估计有3.7%出现血流或中枢神经系统S。金黄色葡萄球菌感染，可归因死亡率为25%。尽管采取了积极措施来防止S。新生儿金黄色葡萄球菌感染、S.金黄色葡萄球菌病在该人群中仍然很高。我们提出了一种新的防止S.新生儿金黄色葡萄球菌HAI。父母而不是医务人员可能是新生儿获得S的关键贮存器。新生儿重症监护室的金黄色葡萄球菌定植。这一发现与不断变化的NICU环境相一致，在NICU环境中，鼓励父母和新生儿之间的皮肤接触，并可能促进S。金黄色葡萄球菌的传播，而同时，常见的医院感染预防措施已经减少了医护人员的传播。金黄色。本提案的长期目标是预防新生儿HAI，特别是由S.金黄色的具体目的是目的1）评估S.目的2）测定用短程鼻内莫匹罗星和局部氯己定消毒剂治疗父母对金黄色葡萄球菌获得的影响。新生儿金黄色葡萄球菌定植的随机对照试验。我们将收集入住NICU的新生儿及其父母的队列，并对他们进行纵向随访，以测量S的获得。目的探讨新生儿重症监护病房（NICU）新生儿金黄色葡萄球菌（S. aureus）定植情况，并探讨父母在新生儿S.金黄色葡萄球菌传播。一些新生儿-父母配对将被随机化，父母将接受治疗或对照以根除S。金黄色葡萄球菌定植。本提案的研究结果可能会改变NICU HAI预防的范式，从关注医护人员和环境，转变为认识到父母和来访者是导致HAI的病原体暴露的重要来源。

DESCRIPTION (provided by applicant): Each year in the U.S. nearly 500,000 babies are born prematurely. Premature births are a leading cause of long-term neurologic disabilities in children and cost more than $26 billion per year. Premature infants are cared for in the neonatal intensive care unit (NICU) where more than 33,000 develop a healthcare associated infection (HAI). HAIs are estimated to result in $28-45 billion in healthcare costs annually. In addition to the short-term costs of HAIs, neonatal infections contribute to devastating neurologic disabilities and poor growth outcomes. Staphylococcus aureus (S. aureus) is the second most common pathogen causing HAIs in neonates. Out of 57,000 very low birth weight infants, an estimated 3.7% develop bloodstream or central nervous system S. aureus infections annually with an attributable mortality of 25%. Despite aggressive measures to prevent S. aureus infections in neonates, the burden of S. aureus disease remains high in this population. We propose a new paradigm to prevent S. aureus HAIs in neonates. Parents, rather than healthcare workers, may be a key reservoir from which neonates acquire S. aureus colonization in the NICU. This finding is consistent with a changing NICU environment where skin-to-skin contact between parents and neonates is encouraged and may promote S. aureus transmission, while at the same time, common hospital infection prevention measures have reduced healthcare worker transmission of S. aureus. The long term objective of this proposal is to prevent HAIs in neonates, especially those caused to S. aureus. The specific aims are Aim 1) to assess S. aureus colonization and strain concordance amongst parents and neonates in the NICU, Aim 2) to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonization in neonates in a randomized controlled trial. We will assemble a cohort of neonates admitted to the NICU and their parents and follow them longitudinally to measure acquisition of S. aureus colonization in neonates in the NICU and determine the role of parents in postnatal S. aureus transmission. Some neonate-parent pairs will be randomized, and parents will receive treatment or control to eradicate S. aureus colonization. The findings of this proposal could change the paradigm of HAI prevention in the NICU from one that focuses on healthcare workers and the environment to one that recognizes parents and visitor as important sources of exposure to pathogens that contribute to HAIs.