Nasal mupirocin ointment decreases the incidence of Staphylococcus aureus bacteraemias in haemodialysis patients.
The incidence of S. aureus bacteraemia in a haemodialysis unit was studied over 2 years (167.75 patient-years of follow-up) during which nasal calcium mupirocin was used to eradicate nasal S. aureus carriage; this incidence was compared to that previously observed in the same unit before the use of nasal mupirocin (185.8 patient-years). Nasal mupirocin led to eradication of nasal S. aureus carriage in 96.3% of surveillance cultures and to a fourfold reduction in the incidence of S. aureus bacteraemia per patient-year, from 0.097 before mupirocin to 0.024 with mupirocin use (P = 0.008). Once or thrice weekly maintenance regimens of mupirocin were equally efficacious. The incidence of bacteraemia caused by other micro-organisms was not significantly affected. One single mupirocin-resistant isolate was identified in a nasal surveillance culture. Eradication of S. aureus from the nares did not lead to overgrowth by other micro-organisms. Chemoprophylaxis with nasal mupirocin in haemodialysis patients is cost-effective.
Unit for Renal and Infectious Diseases, Algemeen Ziekenhuis Sint Jan, Brugge, Belgium.
J R
JR
Boelaert
H W
HW
Van Landuyt
C A
CA
Godard
R F
RF
Daneels
M L
ML
Schurgers
E G
EG
Matthys
Y A
YA
De Baere
D W
DW
Gheyle
B Z
BZ
Gordts
L A
LA
Herwaldt
D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000517:prevention & control*; D002353:Carrier State / Q000188:drug therapy; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage* / Q000627:therapeutic use; D009666:Nose / Q000382:microbiology*; D009824:Ointments; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects*
D009824:Ointments; D016712:Mupirocin