Safety of targeted perioperative mupirocin treatment for preventing infections after cardiac surgery.
BACKGROUND
Indiscriminate antibiotic use may lead to development of antibiotic resistance. Preoperative mupirocin treatment decreases Staphylococcus aureus carriage and may reduce subsequent surgical site infection, but is unlikely to benefit noncarriers. This study was undertaken to evaluate whether avoiding mupirocin in noncarriers places them at increased risk for subsequent postoperative infection.


METHODS
We conducted a retrospective cohort study examining incidence of postoperative infection in patients undergoing cardiac surgery at the Cleveland Clinic after introduction of a protocol of polymerase chain reaction screening for nasal S aureus carriage, and avoiding mupirocin treatment of noncarriers.


RESULTS
Between August 1, 2002, and May 31, 2004, 6,334 patients were screened for nasal carriage of S aureus before undergoing cardiac surgery. There was no significant difference in infection rates between carriers and noncarriers when examining the incidence of all infections (5.6% and 5.0%; relative risk [RR] 1.11 [95% confidence interval (CI): 0.86 to 1.43]), infections caused specifically by S aureus (1.04% and 0.80%; RR 1.30 [95% CI: 0.71 to 2.39]), any surgical site infection (3.1% and 3.2%; RR 0.97 [95% CI: 0.69 to 1.36]), S aureus surgical site infection (0.82% and 0.58%; RR 1.41 [95% CI: 0.71 to 2.82]), any bloodstream infection (3.1% and 2.5%; RR 1.21 [95% CI: 0.86 to 1.71]), and S aureus bloodstream infection (0.37% and 0.48%; RR 0.77 [95% CI: 0.30 to 2.03]). Mupirocin use declined substantially after introduction of the protocol.


CONCLUSIONS
A strategy of targeting perioperative mupirocin treatment to carriers leads to significant reduction in mupirocin use without increasing early postoperative infectious complications in noncarriers.
Shrestha
Nabin K
NK
Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. shrestn@ccf.org
Banbury
Michael K
MK
Weber
Monica
M
Cwynar
Roberta E
RE
Lober
Cheryl
C
Procop
Gary W
GW
Karafa
Matthew T
MT
Gordon
Steven M
SM
D000368:Aged; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000706:statistics & numerical data; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002353:Carrier State / Q000188:drug therapy*; D015331:Cohort Studies; D015897:Comorbidity; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use*; D009296:Nasal Cavity / Q000382:microbiology*; D009820:Ohio / Q000453:epidemiology; D018579:Patient Selection; D016133:Polymerase Chain Reaction; D011229:Preanesthetic Medication / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D019564:Unnecessary Procedures
D016712:Mupirocin