Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.
BACKGROUND
Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.


METHODS
In a randomized, double-blind, placebo-controlled, multicenter trial, we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated S. aureus infection.


RESULTS
From October 2005 through June 2007, a total of 6771 patients were screened on admission. A total of 1270 nasal swabs from 1251 patients were positive for S. aureus. We enrolled 917 of these patients in the intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504 patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group (relative risk of infection, 0.42; 95% confidence interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21; 95% CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital mortality between the two groups. The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group (P=0.005).


CONCLUSIONS
The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.)
Bode
Lonneke G M
LG
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. l.bode@erasmusmc.nl
Kluytmans
Jan A J W
JA
Wertheim
Heiman F L
HF
Bogaers
Diana
D
Vandenbroucke-Grauls
Christina M J E
CM
Roosendaal
Robert
R
Troelstra
Annet
A
Box
Adrienne T A
AT
Voss
Andreas
A
van der Tweel
Ingeborg
I
van Belkum
Alex
A
Verbrugh
Henri A
HA
Vos
Margreet C
MC
D000281:Administration, Intranasal; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy; D002423:Cause of Death; D002710:Chlorhexidine / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000009:adverse effects / Q000627:therapeutic use*; D009296:Nasal Cavity / Q000382:microbiology*; D009824:Ointments; D016133:Polymerase Chain Reaction; D012867:Skin / Q000382:microbiology; D012915:Soaps / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000890:Anti-Infective Agents; D009824:Ointments; D012915:Soaps; D016712:Mupirocin; D002710:Chlorhexidine