title: Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.
abstract: 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.)
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. l.bode@erasmusmc.nl
authors.forename: Lonneke G M
authors.initials: LG
authors.lastname: Bode
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
authors.forename: Heiman F L
authors.initials: HF
authors.lastname: Wertheim
authors.forename: Diana
authors.initials: D
authors.lastname: Bogaers
authors.forename: Christina M J E
authors.initials: CM
authors.lastname: Vandenbroucke-Grauls
authors.forename: Robert
authors.initials: R
authors.lastname: Roosendaal
authors.forename: Annet
authors.initials: A
authors.lastname: Troelstra
authors.forename: Adrienne T A
authors.initials: AT
authors.lastname: Box
authors.forename: Andreas
authors.initials: A
authors.lastname: Voss
authors.forename: Ingeborg
authors.initials: I
authors.lastname: van der Tweel
authors.forename: Alex
authors.initials: A
authors.lastname: van Belkum
authors.forename: Henri A
authors.initials: HA
authors.lastname: Verbrugh
authors.forename: Margreet C
authors.initials: MC
authors.lastname: Vos
mesh_terms: 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*
chemical_list: D000890:Anti-Infective Agents; D009824:Ointments; D012915:Soaps; D016712:Mupirocin; D002710:Chlorhexidine