Effect of Intranasal Mupirocin Prophylaxis on Methicillin-Resistant Staphylococcus aureus Transmission and Invasive Staphylococcal Infections in a Neonatal Intensive Care Unit.

The use of monthly intranasal mupirocin was associated with a significant reduction in the rate of methicillin-resistant Staphylococcus aureus transmission and Staphylococcus aureus invasive infection in a large neonatal intensive care unit. Resistance to mupirocin emerged over time, but it was rare and was not associated with adverse clinical outcomes.Infect Control Hosp Epidemiol 2018;39:741-745.

Nasopharyngeal colonization with heptavalent pneumococcal conjugate vaccine serotypes of Streptococcus pneumoniae with prolonged vaccine dosing intervals.

INTRODUCTION: Universal infant heptavalent pneumococcal conjugate vaccine (PCV-7) immunization, dosed near to the originally recommended schedule of a 3-dose series in the first 6 months of life, then a booster between 12 and 15 months, should reduce nasopharyngeal (NP) carriage of Streptococcus pneumoniae (Spn) PCV-7 types. The reduced availability of PCV-7 altered immunization schedules, particularly for third and fourth PCV-7 doses. We evaluated NP colonization in relation to originally recommended intervals and numbers of PCV-7 doses. METHODS: Spn from NP cultures of a cohort of 106 normal children, obtained during 20 months of PCV-7 shortage, were identified and serotyped by standard methods. RESULTS: Spn was detected in 153 of 418 cultures (37%). Age, >1 sibling, day-care attendance and prolonged PCV-7 dosing intervals were univariate risks for NP detection of PCV-7 types. PCV-7 strains comprised 7 of 15 (47%) of Spn before the first dose, 28 of 36 (78%) and 27 of 41 (66%), respectively, after the first and second dose and then 16 of 36 (44%) and 11 of 25 (44%) after the third and fourth doses. The risk of NP colonization with PCV-7 types was higher with intervals of >3 months between second and third doses and intervals of >8 months between the third and fourth doses. Multivariate analysis showed prolonged interval after the second and third PCV-7 doses and day-care attendance as risk factors for NP detection of PCV-7 strains. CONCLUSION: Although PCV-7 serotypes were detected less after third and fourth PCV-7 doses, longer dosing intervals, particularly in day-care attendees, were associated with higher risk of PCV-7 detection in the NP.

Antibodies reactive to Rickettsia rickettsii among children living in the southeast and south central regions of the United States.

BACKGROUND: The reported annual incidence of Rocky Mountain spotted fever in the United States is 2.2 per million, but studies have suggested that human infection with Rickettsia rickettsii may be more common. This study estimated the prevalence of antibodies reactive to R rickettsii among children living in the southeastern and south central United States. STUDY DESIGN: Approximately 300 specimens were obtained from children at each of 7 pediatric referral centers (N = 1999). Serum was tested for R rickettsii antibodies by means of indirect immunofluorescence antibody assay. Three different cutoff titers (>or=64, >or=128, and >or=256) represented increasing levels of stringency to define positive specimens. RESULTS: Overall, 12.0% of children had R rickettsii antibody titers of at least 64; 7.3%, at least 128; and 4.3%, at least 256. Strong relationships were seen between increasing age and seroprevalence at each cutoff titer. Remarkably, 6.4% of children aged 13 to 17 years had titers of at least 256. Age-adjusted seroprevalence rates at titers of at least 64 varied from 21.9% in Little Rock, Ark, to 3.5% in Louisville, Ky. At titers of at least 256, seroprevalence ranged from 7.7% in Nashville, Tenn, to 1.8% in Winston-Salem, NC. Only site and age group were strong predictors of seropositivity; a weak association was seen with nonurban residence. CONCLUSIONS: To our knowledge, this is the largest serosurvey of rickettsial infection in children in the United States. Within the limitations of the immunofluorescence antibody assay, these data suggest that infections with R rickettsii or antigenically related spotted-fever group rickettsiae may be common and subclinical. The results also have implications for the interpretation of single immunofluorescence antibody assay titers in children with suspected Rocky Mountain spotted fever.

Cytomegalovirus seroprevalence among women of childbearing age during a 10-year period.

The incidence of congenital cytomegalovirus (CMV) disease is dependent on the rate of virus acquisition by susceptible women in temporal proximity to pregnancy. Information about serostatus may help to identify high-risk groups and target interventions. Each year from 1991 to 2000, cord blood specimens (surrogates for maternal serum) from 100 consecutive deliveries were obtained at three hospitals. The presence of CMV immunoglobulin G antibody was correlated with demographic data. Overall, 58% of 2992 women were seropositive. After stratification by socioeconomic status (SES), nonwhite race was strongly associated with seropositivity (odds ratio, 3.0; 95% confidence interval [CI], 2.5 to 3.8), and after stratification by race, lower SES also was associated (odds ratio, 2.0; 95% CI, 1.7 to 2.3). There were no trends in seroprevalence over time in any demographic group. However, among white women 21 to 29 years of age, a significant association was found with later birth cohort. Seropositivity ranged from 40% among older, white primigravidas of upper SES to 89% among older, nonwhite, multigravid women of lower SES. These data suggest high rates of CMV transmission among nonwhite women of lower SES. Because these women tended to deliver infants at younger ages, delaying pregnancy even a few years might reduce the incidence of congenital disease. In contrast, most white, upper SES women remain susceptible to primary infection during their childbearing years. Such women born after 1975 may be more likely to reach the childbearing years with CMV immunity as compared with women born before then.