title: Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution.
abstract: BACKGROUND
  Treatment of Staphylococcus aureus colonization before surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone-iodine solution may provide an alternative to mupirocin.
  
  
  METHODS
  We conducted an investigator-initiated, open-label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical chlorhexidine wipes in combination with either twice daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidone-iodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery.
  
  
  RESULTS
  In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P = .1); S. aureus deep SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidone-iodine group (P = .2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P = .03).
  
  
  CONCLUSIONS
  Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01313182.
authors.affiliation: New York University Hospital Center, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenberg
authors.forename: Bo
authors.initials: B
authors.lastname: Shopsin
authors.forename: Germaine
authors.initials: G
authors.lastname: Cuff
authors.forename: Faith
authors.initials: F
authors.lastname: Skeete
authors.forename: Alycia
authors.initials: A
authors.lastname: Foti
authors.forename: Kandy
authors.initials: K
authors.lastname: Kraemer
authors.forename: Kenneth
authors.initials: K
authors.lastname: Inglima
authors.forename: Robert
authors.initials: R
authors.lastname: Press
authors.forename: Joseph
authors.initials: J
authors.lastname: Bosco
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001178:Arthroplasty; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage* / Q000494:pharmacology; D009666:Nose / Q000382:microbiology; D009824:Ointments; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000494:pharmacology; D013123:Spinal Fusion; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D009824:Ointments; D011206:Povidone-Iodine; D016712:Mupirocin