Intranasal Mupirocin to Prevent Postoperative<i>Staphylococcus aureus</i>Infections

TLDR

Patients with nasal carriage of Staphylococcus aureus have an increased risk of surgical‑site infections caused by that organism. The study aimed to determine whether intranasal mupirocin reduces postoperative S. aureus surgical‑site infections and other nosocomial infections in a randomized, double‑blind, placebo‑controlled trial of 3,864 surgical patients. The trial randomized 3,864 patients to intranasal mupirocin or placebo, with 444 of the 891 nasal carriers receiving mupirocin and 447 receiving placebo.

Abstract

Patients with nasal carriage of Staphylococcus aureus have an increased risk of surgical-site infections caused by that organism. Treatment with mupirocin ointment can reduce the rate of nasal carriage and may prevent postoperative S. aureus infections.We conducted a randomized, double-blind, placebo-controlled trial to determine whether intranasal treatment with mupirocin reduces the rate of S. aureus infections at surgical sites and prevents other nosocomial infections.Of 4030 enrolled patients who underwent general, gynecologic, neurologic, or cardiothoracic surgery, 3864 were included in the intention-to-treat analysis. Overall, 2.3 percent of mupirocin recipients and 2.4 percent of placebo recipients had S. aureus infections at surgical sites. Of the 891 patients (23.1 percent of the 3864 who completed the study) who had S. aureus in their anterior nares, 444 received mupirocin and 447 received placebo. Among the patients with nasal carriage of S. aureus, 4.0 percent of those who received mupirocin had nosocomial S. aureus infections, as compared with 7.7 percent of those who received placebo (odds ratio for infection, 0.49; 95 percent confidence interval, 0.25 to 0.92; P=0.02).Prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections overall, but it did significantly decrease the rate of all nosocomial S. aureus infections among the patients who were S. aureus carriers.