title: Reduction in Staphylococcus aureus wound colonization using nasal mupirocin and selective decontamination of the digestive tract in extensive burns.
abstract: Following the introduction in 1988 of a regimen of selective decontamination of the digestive tract (SDD) for extensively injured patients in our burns centre, colonization rates with Gram-negative organisms declined significantly, but colonization with Staphylococcus aureus was unaffected. In an effort to reduce staphylococcal colonization, the SDD regimen has been supplemented with intranasal mupirocin since 1991. In this paper, 33 consecutive patients with burns of > 30 per cent TBSA who were treated with the supplemental regimen (SDD + M) in 1991 and 1992, were compared with 34 consecutive patients admitted in the previous 2 years who were treated with SDD only. Staph. aureus colonization of wounds, sputum and gastric aspirates was significantly reduced in the SDD + M group. Gram-negative colonization rates and the incidence of clinical infections remained low in both groups. Our experience suggests that decontamination of endogenous bacterial reservoirs, in combination with isolation measures to prevent exogenous colonization, effectively prevents infectious complications in patients with severe burns.
authors.affiliation: Rode Kruis Ziekenhuis, Anaesthesiology Department, Beverwijk, The Netherlands.
authors.forename: D P
authors.initials: DP
authors.lastname: Mackie
authors.forename: W A
authors.initials: WA
authors.lastname: van Hertum
authors.forename: T H
authors.initials: TH
authors.lastname: Schumburg
authors.forename: E C
authors.initials: EC
authors.lastname: Kuijper
authors.forename: P
authors.initials: P
authors.lastname: Knape
authors.forename: F
authors.initials: F
authors.lastname: Massaro
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004064:Digestive System / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage*; D009824:Ointments; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000254:growth & development; D014946:Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D009824:Ointments; D016712:Mupirocin