Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections.

BACKGROUND Patients with nasal carriage of Staphylococcus aureus have an increased risk of surgical-site infections caused by that organism. Treatment with mupirocin ointment can reduce the rate of nasal carriage and may prevent postoperative S. aureus infections. METHODS We conducted a randomized, double-blind, placebo-controlled trial to determine whether intranasal treatment with mupirocin reduces the rate of S. aureus infections at surgical sites and prevents other nosocomial infections. RESULTS Of 4030 enrolled patients who underwent general, gynecologic, neurologic, or cardiothoracic surgery, 3864 were included in the intention-to-treat analysis. Overall, 2.3 percent of mupirocin recipients and 2.4 percent of placebo recipients had S. aureus infections at surgical sites. Of the 891 patients (23.1 percent of the 3864 who completed the study) who had S. aureus in their anterior nares, 444 received mupirocin and 447 received placebo. Among the patients with nasal carriage of S. aureus, 4.0 percent of those who received mupirocin had nosocomial S. aureus infections, as compared with 7.7 percent of those who received placebo (odds ratio for infection, 0.49; 95 percent confidence interval, 0.25 to 0.92; P=0.02). CONCLUSIONS Prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections overall, but it did significantly decrease the rate of all nosocomial S. aureus infections among the patients who were S. aureus carriers.

[1]  R. Brown,et al.  Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. , 2001, Annals of Thoracic Surgery.

[2]  H Stammer,et al.  Nasal Carriage as a Source of Staphylococcus aureus Bacteremia , 2001 .

[3]  W E Wilkinson,et al.  The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs , 1999, Infection Control & Hospital Epidemiology.

[4]  Wayne N. Campbell,et al.  Head-injured patients who are nasal carriers of Staphylococcus aureus are at high risk for Staphylococcus aureus pneumonia. , 1999, Critical care medicine.

[5]  T. Perl,et al.  New Approaches to Reduce Staphylococcus Aureus Nosocomial Infection Rates: Treating S. Aureus Nasal Carriage , 1998, The Annals of pharmacotherapy.

[6]  P. Edixhoven,et al.  Prophylactic mupirocin could reduce orthopedic wound infections. 1,044 patients treated with mupirocin compared with 1,260 historical controls. , 1998, Acta orthopaedica Scandinavica.

[7]  A. van Belkum,et al.  Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks , 1997, Clinical microbiology reviews.

[8]  F. Tenover,et al.  How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. , 1997 .

[9]  F. Tenover,et al.  How to Select and Interpret Molecular Strain Typing Methods for Epidemiological Studies of Bacterial Infections A Review for Healthcare Epidemiologists , 1997, Infection Control & Hospital Epidemiology.

[10]  L. Miller,et al.  Interpretive criteria for testing susceptibility of staphylococci to mupirocin , 1997, Antimicrobial agents and chemotherapy.

[11]  H. Verbrugh,et al.  Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. , 1996 .

[12]  H. Verbrugh,et al.  Elimination of Nasal Carriage of Staphylococcus aureus in Hemodialysis Patients , 1996, Infection Control & Hospital Epidemiology.

[13]  H. Verbrugh,et al.  Reduction of Surgical-Site Infections in Cardiothoracic Surgery by Elimination of Nasal Carriage of Staphylococcus aureus , 1996, Infection Control & Hospital Epidemiology.

[14]  B. Bloom,et al.  Clinical and economic effects of mupirocin calcium on preventing Staphylococcus aureus infection in hemodialysis patients: a decision analysis. , 1996, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[15]  J. Ariza,et al.  Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. , 1996, The American journal of medicine.

[16]  R. Wenzel,et al.  The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. , 1995, The Journal of hospital infection.

[17]  S. Wilson,et al.  Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. , 1994, Anesthesia and analgesia.

[18]  R. Gaynes,et al.  An overview of nosocomial infections, including the role of the microbiology laboratory , 1993, Clinical Microbiology Reviews.

[19]  B. Doebbeling,et al.  Elimination of Staphylococcus aureus Nasal Carriage in Health Care Workers: Analysis of Six Clinical Trials with Calcium Mupirocin Ointment , 1993 .

[20]  R. Gaynes,et al.  Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System. , 1993 .

[21]  R. Wenzel,et al.  Restriction endonuclease analysis of plasmid DNA from methicillin-resistant Staphylococcus aureus: clinical application over a three-year period. , 1993 .

[22]  L. Herwaldt,et al.  Nasal mupirocin ointment decreases the incidence of Staphylococcus aureus bacteraemias in haemodialysis patients. , 1993, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[23]  J. Boelaert,et al.  Side-effects of desferrioxamine in dialysis patients. , 1993, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[24]  W J Martone,et al.  Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. , 1991, The American journal of medicine.

[25]  J. Boelaert,et al.  The use of nasal mupirocin ointment to prevent Staphylococcus aureus bacteraemias in haemodialysis patients: an analysis of cost-effectiveness. , 1991, The Journal of hospital infection.

[26]  B. Doebbeling,et al.  Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. , 1991, Annals of internal medicine.

[27]  R. Wenzel,et al.  NOSOCOMIAL INFECTIONS: VALIDATION OF SURVEILLANCE AND COMPUTER MODELING TO IDENTIFY PAT AT RISK , 1990 .

[28]  J. Boyce,et al.  Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. , 1990, Infection control and hospital epidemiology.

[29]  J M Hughes,et al.  CDC definitions for nosocomial infections, 1988. , 1988, American journal of infection control.

[30]  R. M. Nelson,et al.  The economic implications of infection in cardiac surgery. , 1986, The Annals of thoracic surgery.

[31]  L. Laliberte,et al.  The Karnofsky performance status scale: An examination of its reliability and validity in a research setting , 1984, Cancer.

[32]  R. Wenzel,et al.  Postoperative Wound Infection: A Controlled Study of the Increased Duration of Hospital Stay and Direct Cost of Hospitalization , 1977, Annals of surgery.

[33]  G. Jackson,et al.  Gram-Negative Bacteremia. II. Clinical, Laboratory, and Therapeutic Observations. , 1962 .