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Title: Topical Antibiotics Reduce Postoperative Infections In Staphylococcus aureus Carriers

URL: http://content.nejm.org/cgi/content/abstract/346/24/1871

NEJM, 2002; 346: 1871-1877. "Intranasal Mupirocin to Prevent Postoperative Staphylococcus aureus Infections"
06/13/2002 08:05:25 AM
By Elda Hauschildt

Topical antibiotic treatment is effective in reducing the rate of [Staphylococcus aureus infections at surgical sites in a subgroup of patients who are nasal carriers of S. aureus. Researchers from the University of Iowa in Iowa City and the Johns Hopkins Medical Institutions in Baltimore, Maryland, United States, say prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections overall. However, this randomised, double-blind placebo-controlled trial indicated found that prophylactic use significantly decreased the rate of all nosocomial infections among patients who are S. aureus carriers. They state: "We conclude that mupirocin therapy is safe, has a protective effect among nasal carriers of S. aureus and is a reasonable adjuvant agent to prevent such infections in carriers after surgery." Study participants involved 4,030 patients undergoing general, gynaecologic, neurologic or cardiothoracic surgery, 3,864 were included in intention-to-treat analysis. Overall, 2.3 percent of patients receiving mupirocin and 2.4 of those receiving placebo developed S. aureus infections at surgical sites. A total of 891 participants (23.1 percent of those completing the study) had S. aureus in their anterior nares. Researchers randomised 444 of these patients to mupirocin and 447 to placebo. Among these patients, 4.0 percent of those receiving mupirocin had nosocomial S. aureus infections, compared with 7.7 percent of those who received placebo. Investigators note that there is a concern that prophylactic use of mupirocin could lead to widespread resistance: "Using the short and defined course of mupirocin prescribed by the protocol, we identified only four isolates that were resistant to mupirocin, three of which were obtained from patients who were not treated by mupirocin. "Thus, a single, short course of mupirocin for preoperative prophylaxis did not appear to select for mupirocin-resistant S. aureus isolates."

http://content.nejm.org/cgi/content/abstract/346/24/1871

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