A double-blind, randomized, controlled trial of topical polysporin triple compound versus topical mupirocin for the eradication of colonization with methicillin-resistant Staphylococcus aureus in a complex continuing care population.
BACKGROUND
Intranasal mupirocin or Polysporin Triple (PT) ointment (polymyxin B, bacitracin, gramicidin), in combination with chlorhexidine body washes, have been used for eradicating methicillin-resistant Staphylococcus aureus (MRSA), but no comparative studies have been done.


METHODS
A double-blind, randomized, controlled clinical trial to compare the efficacy of mupirocin versus PT ointment in combination with chlorhexidine body washes in eradicating MRSA carriage was conducted. Asymptomatic MRSA carriers, medically stable and at least 18 years of age who were patients on medical wards, received twice daily application of either mupirocin or PT ointment to the anterior nares plus once daily 2% chlorhexidine body washes for seven days. Follow-up swabs from multiple sites using broth enrichment were conducted at 48 h, and one, two, four, eight and 12 weeks.


RESULTS
Of 103 patients eligible for analysis (54 mupirocin; 49 PT), no significant differences between the two groups with respect to baseline demographics, risk factors for MRSA or MRSA colonization sites were noted. At 48 h, 35 of 54 (65%) patients in the mupirocin group versus 15 of 49 (31%) in the PT group (P=0.001) were found to be MRSA negative at all sites. Significant differences were observed at one and two weeks but were not maintained at other intervals. In those with complete microbiological follow-up, MRSA eradication at all sites occurred in 12 of 39 (30.8%) mupirocin- and one of 36 (2.8%) PT-treated patients (P=0.001).


CONCLUSIONS
Both agents demonstrated poor efficacy and PT was significantly less efficacious than mupirocin at 12 weeks in eradicating MRSA from all sites.
O'Grady
S
S
Bridgepoint Health;
Hirji
Z
Z
Pejcic-Karapetrovic
B
B
Fung
S
S
Dedier
H
H
Takata-Shewchuk
J
J
Zhang
K
K
Conly
J
J
Perit Dial Int. 2001 Nov-Dec;21(6):554-9
11783763
Infect Control Hosp Epidemiol. 2007 Sep;28(9):1036-43
17932823
J Infect Dis. 2002 Sep 1;186(5):652-60
12195352
CMAJ. 2001 Nov 13;165(10):1339-41
11760981
J Hosp Infect. 2001 Aug;48 Suppl A:S9-14
11759035
N Engl J Med. 1998 Aug 20;339(8):520-32
9709046
Infect Control Hosp Epidemiol. 2001 Aug;22(8):505-9
11700878
Gerontologist. 1970 Spring;10(1):20-30
5420677
Infect Control Hosp Epidemiol. 2000 Oct;21(10):653-5
11083183
Infect Control Hosp Epidemiol. 2001 Mar;22(3):152-6
11310693
Infect Control Hosp Epidemiol. 2001 Sep;22(9):578-80
11732789
J Am Soc Nephrol. 2003 Jan;14(1):169-79
12506149
J Antimicrob Chemother. 1998 Nov;42(5):577-83
9848440
J Hosp Infect. 1998 Aug;39(4):253-90
9749399
J Clin Microbiol. 2001 Oct;39(10):3481-5
11574559
Clin Infect Dis. 2007 Jan 15;44(2):178-85
17173213
Infect Control Hosp Epidemiol. 1996 Dec;17(12):811-3
8985769
Infect Control Hosp Epidemiol. 1996 Dec;17(12):775-9
8985762
Am J Med. 1999 May 3;106(5A):2S-10S; discussion 48S-52S
10348058
Am J Med. 1993 Apr;94(4):371-8
8475930
J Antimicrob Chemother. 1988 Sep;22(3):377-84
3141347
Infect Control Hosp Epidemiol. 2003 May;24(5):362-86
12785411
Infect Control Hosp Epidemiol. 2000 Jul;21(7):459-64
10926396
Clin Infect Dis. 2003 Oct 1;37(7):933-8
13130405
Infect Control Hosp Epidemiol. 1996 Jan;17(1):20-8
8789683
Infect Control Hosp Epidemiol. 1996 Dec;17(12):813-6
8985770
Lancet. 1997 Dec 6;350(9092):1670-3
9400512
J Clin Microbiol. 2005 Oct;43(10):5026-33
16207957
J Clin Microbiol. 2004 Nov;42(11):4947-55
15528678
N Engl J Med. 2001 Jan 4;344(1):11-6
11136954
Antimicrob Agents Chemother. 1999 Jun;43(6):1412-6
10348762
Clin Microbiol Rev. 1997 Jul;10(3):505-20
9227864