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.
Perl
Trish M
TM
University of Iowa Colleges of Medicine and Public Health, Iowa City, USA.
Cullen
Joseph J
JJ
Wenzel
Richard P
RP
Zimmerman
M Bridget
MB
Pfaller
Michael A
MA
Sheppard
Deborah
D
Twombley
Jennifer
J
French
Pamela P
PP
Herwaldt
Loreen A
LA
D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D003428:Cross Infection / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use*; D009666:Nose / Q000382:microbiology; D009824:Ointments; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D009824:Ointments; D016712:Mupirocin