Controlling the usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

“…More recently, an intervention in the setting of hyperendemic MRSA colonization (point prevalence for MRSA carriage = 38%) and subsequent MRSA infection on four orthopedic surgery wards reported a reduction in (MRSA) infection by using universal mupirocin decolonization and preoperative 2% triclosan bathing [18]. Other reports support our approach by suggesting preoperative surveillance for S. aureus to limit the unnecessary use of mupirocin [10,12]. Surveillance cultures of anterior nares in those about to undergo cardiothoracic surgery was followed by mupirocin prophylaxis on all patients [12].…”

“…Other reports support our approach by suggesting preoperative surveillance for S. aureus to limit the unnecessary use of mupirocin [10,12]. Surveillance cultures of anterior nares in those about to undergo cardiothoracic surgery was followed by mupirocin prophylaxis on all patients [12]. When the cultures were completed (at 48 hours) they were able to discontinue mupirocin therapy in 79% of their patients and limit unnecessary mupirocin treatment to 2 days.…”

“…We therefore evaluated a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. We first wanted to confirm our in-house molecular diagnostic assay [12] could be used as a rapid test for detecting S. aureus in surgical patients and to assess the costs. We then raised three questions: (1) Are S. aureus SSIs the major cause of postoperative infection in our hip and knee surgical population?…”

“…During this time period methicillin-resistant S. aureus (MRSA) nearly doubled [1]. Molecular DNA analysis of S. aureus isolates causing SSI reveals a majority of the infecting strains are part of the patient's resident normal nasal flora [12]. Perl and colleagues report this rate as high as 84.6% [15].…”

“…We first wanted to confirm our in-house molecular diagnostic assay [12] could be used as a rapid test for detecting S. aureus in surgical patients and to assess the costs. We then raised three questions: (1) Are S. aureus SSIs the major cause of postoperative infection in our hip and knee surgical population?…”