Background HIV-positive patients at HELP/PSI, Inc., an in-patient drug rehabilitation center, had a high baseline prevalence of S. aureus colonization (49%) and incidence of infection (17%) in a previous year long study. Methods A randomized, double-blinded, placebo-controlled study was conducted to determine whether repeated nasal application of mupirocin ointment would decrease the odds of S. aureus nasal colonization in 100 HELP/PSI patients over an eight-month period. A five-day course of study drug was given monthly and colonization was assessed at baseline and one month after each treatment. S. aureus infection was a secondary outcome. Results In repeated-measures analysis, mupirocin reduced the odds of monthly S. aureus nasal colonization by 83% compared to placebo (ORadj=0.17; P<0.0001). Subjects colonized at study entry had a 91% reduction in subsequent colonization (ORadj=0.09; P<0.0001). Mupirocin also suppressed S. aureus colonization in subjects not colonized at baseline (ORadj=0.23; P=0.006). There was no difference in infection rates between the mupirocin and placebo groups (HR=0.49, P=0.29). Conclusions Monthly application of nasal mupirocin significantly decreased S. aureus colonization in HIV patients in residential drug rehabilitation. Monthly mupirocin application has a potential role in long-term care settings or in HIV-positive patients with high rates of S. aureus colonization and infection.

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