title: Perioperative intranasal mupirocin for the prevention of surgical-site infections: systematic review of the literature and meta-analysis.
abstract: OBJECTIVE
  To review the evidence evaluating perioperative intranasal mupirocin for the prevention of surgical-site infections according to type of surgical procedure.
  
  
  METHODS
  Systematic review and meta-analysis of published clinical trials.
  
  
  METHODS
  Studies included were either randomized clinical trial or prospective trials at a single institution that measured outcomes both before and after an institution-wide intervention (before-after trial). In all studies, intervention and control groups differed only by the use of perioperative intranasal mupirocin in the intervention group.
  
  
  METHODS
  Patients undergoing general or nongeneral surgery (eg, cardiothoracic surgery, orthopedic surgery, and neurosurgery).
  
  
  METHODS
  Risk of surgical-site infection following perioperative intranasal mupirocin versus usual care.
  
  
  RESULTS
  Three randomized and four before-after trials met the inclusion criteria. No reduction in surgical-site infection rate was seen in randomized general surgery trials (summary estimates: 8.4% in the mupirocin group and 8.1% in the control group; relative risk [RR], 1.04; 95% confidence interval [CI95], 0.81 to 1.33). In nongeneral surgery, the use of mupirocin was associated with a reduction in surgical-site infection in randomized trials (summary estimates: 6.0% in the mupirocin group and 7.6% in the control group; RR, 0.80; CI95, 0.58 to 1.10) and in before-after trials (summary estimates: 1.7% in the mupirocin group and 4.1% in the control group; RR, 0.40; CI95, 0.29 to 0.56).
  
  
  CONCLUSIONS
  Perioperative intranasal mupirocin appears to decrease the incidence of surgical-site infection when used as prophylaxis in nongeneral surgery. Given its low risk and low cost, use of perioperative intranasal mupirocin should be considered in these settings.
authors.affiliation: VA Outcomes Group, VA Medical Center, White River Junction, VT 05009, USA. Alexander.J.Kallen@dartmouth.edu
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
authors.forename: Chad T
authors.initials: CT
authors.lastname: Wilson
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Larson
mesh_terms: D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D006801:Humans; D016712:Mupirocin / Q000008:administration & dosage*; D019990:Perioperative Care; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin