The NOSE study (nasal ointment for Staphylococcus aureus eradication): a randomized controlled trial of monthly mupirocin in HIV-infected individuals.
BACKGROUND
HIV-positive patients at HELP/PSI, Inc, an in-patient drug rehabilitation center, had a high baseline prevalence of Staphylococcus aureus colonization (49%) and incidence of infection (17%) in a previous year-long study.


METHODS
A randomized, double-blinded, placebo-controlled study was conducted to determine whether repeated nasal application of mupirocin ointment would decrease the odds of S. aureus nasal colonization in 100 HELP/PSI patients over an 8-month period. A 5-day course of study drug was given monthly, and colonization was assessed at baseline and 1 month after each treatment. S. aureus infection was a secondary outcome.


RESULTS
In repeated-measures analysis, mupirocin reduced the odds of monthly S. aureus nasal colonization by 83% compared with placebo [adjusted odds ratio (ORadj) = 0.17; P < 0.0001]. Subjects colonized at study entry had a 91% reduction in subsequent colonization (ORadj = 0.09; P < 0.0001). Mupirocin also suppressed S. aureus colonization in subjects not colonized at baseline (ORadj = 0.23; P = 0.006). There was no difference in infection rates between the mupirocin and placebo groups (hazard ratio = 0.49, P = 0.29).


CONCLUSIONS
Monthly application of nasal mupirocin significantly decreased S. aureus colonization in HIV patients in residential drug rehabilitation. Monthly mupirocin application has a potential role in long-term care settings or in HIV-positive patients with high rates of S. aureus colonization and infection.
Gordon
Rachel J
RJ
Department of Medicine, Columbia University, New York, NY, USA. rj216@columbia.edu
Chez
Nancy
N
Jia
Haomiao
H
Zeller
Barbara
B
Sobieszczyk
Magda
M
Brennan
Caitlin
C
Hisert
Katherine B
KB
Lee
Mei-Ho
MH
Vavagiakis
Peter
P
Lowy
Franklin D
FD
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000281:Administration, Intranasal; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D016712:Mupirocin / Q000008:administration & dosage*; D009824:Ointments; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D009824:Ointments; D016712:Mupirocin