title: Prevention of Surgical Site Infections: Decontamination With Mupirocin Based on Preoperative Screening for Staphylococcus aureus Carriers or Universal Decontamination?
abstract: Perioperative decolonization of Staphylococcus aureus nasal carriers with mupirocin together with chlorhexidine body washing reduces the incidence of S. aureus surgical site infection. A targeted strategy, applied in S. aureus carriers only, is costly, and implementation may reduce effectiveness. Universal decolonization is more cost-effective but increases exposure of noncarriers to mupirocin and the risk of resistance to mupirocin in staphylococci. High-level mupirocin resistance in S. aureus can emerge through horizontal gene transfer originating from coagulase-negative staphylococci (CoNS) and through clonal transmission. The current evidence on the occurrence of high-level mupirocin resistance in S. aureus and CoNS, in combination with the results of mathematical modeling, strongly suggests that the increased selection of high-level mupirocin resistance in CoNS does not constitute an important risk for high-level mupirocin resistance in S. aureus. Compared with a targeted strategy, universal decolonization seems associated with an equally low risk of mupirocin resistance in S. aureus.
authors.affiliation: Department of Clinical Microbiology.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hetem
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht Department of Mathematics, Utrecht University, The Netherlands.
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Bootsma
authors.affiliation: Department of Clinical Microbiology Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D000281:Administration, Intranasal; D001494:Baths; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003666:Decontamination; D024881:Drug Resistance, Bacterial; D006801:Humans; D008954:Models, Biological; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use*; D009666:Nose / Q000382:microbiology; D009824:Ointments; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D009824:Ointments; D016712:Mupirocin; D002710:Chlorhexidine
keywords: MRSA; decolonization; mupA; mupirocin; prophylaxis