Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics

Cimochowski, George E.; Harostock, Michael; Brown, Robert L.; Bernardi, Mark; Alonzo, Nancy; Coyle, Kathy

doi:10.1016/s0003-4975(01)02519-x

Cited by 185 publications

(101 citation statements)

References 22 publications

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“…Previous studies had different designs, sample sizes, and approaches to intervention, which probably affected the outcomes. Nonrandomized studies with concurrent or historic controls usually involved selective prophylaxis in nasal carriers [5,13] and consistently demonstrated the beneficial effect of mupirocin in patients undergoing orthopaedic [6] or cardiac surgery [2,13]. For example, Gernaat-van der Sluis et al [5] reported prophylactic mupirocin reduced the overall SSI rate after orthopaedic surgery among S. aureus carriers (1.3% versus 2.7%), but not the rate among those with S. aureus SSIs (0.7% versus 1.1%).…”

Section: Discussionmentioning

confidence: 99%

“…Intranasal mupirocin is an attractive prevention strategy because it is a safe and simple method that eradicates nasal colonization in a wide variety of patients [22,31]. It also reduces S. aureus infections in patients undergoing hemodialysis [7,12,27] and SSIs in patients undergoing cardiovascular surgery [2,13], orthopaedic surgery [5], and mixed surgery [21]. Recently, chlorhexidine baths have been added to intranasal mupirocin in an effort to eradicate carriage of methicillin-resistant S. aureus (MRSA) [25,30] and to reduce nosocomial infections caused by MRSA in the intensive care unit [23].…”

Section: Introductionmentioning

confidence: 99%

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A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

Rao

Cannella

Crossett

et al. 2008

Clinical Orthopaedics &Amp; Related Research

180

118

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Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

Rao

Cannella

Crossett

et al. 2008

Clinical Orthopaedics &Amp; Related Research

180

118

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“…In 1996 an unblinded intervention trial using mupirocin for nasal decolonization of all patients (no surveillance for S. aureus was performed) undergoing major cardiothoracic surgery reported a reduction in SSI for in an intervention group compared to historical controls [9]. Subsequently, another paper found similar benefit from S. aureus nasal decolonization in prevention of sternal wound infection for 1846 diabetic and nondiabetic patients undergoing cardiac surgery [3]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…; (2) Will a program of preoperative surveillance for nasal S. aureus carriage followed by decolonization of those patients found to be positive meaningfully reduce S. aureus SSIs? ; (3) What are the costs of infection when it does occur?…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

Hacek

Robb

Paule

et al. 2008

Clinical Orthopaedics &Amp; Related Research

151

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Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of 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. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively.

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“…18 True comparisons among the different studies are difficult because more than 40 different decolonization regimens have been tested in past decades 18 ; intranasal application of mupirocin, by far the most effective topical agent, has limited effectiveness in eradicating extranasal MRSA colonization 1819 ; and randomized or nonrandomized prospective studies were performed mostly with noninfected patients in attempts to decrease the incidence of S. aureus infections in special risk groups 2021 or before orthopedic 11 or cardiothoracic surgery. 22,23 When topical decontamination, frequently associated with systemic antimicrobial therapy, was used for controlling endemic or epidemic conditions of MRSA transmission, even more heterogeneous results have been reported. 24 " 30 The discrepancy in the success rates reported in these studies may result not only from the different regimens of antimicrobials used for MRSA decontamination such as co-trimoxazole, rifampin, ciprofloxacin, minocycline, rifampin, and fusidic acid, but also from the highly different clinical and epidemiologic situations of targeted groups.…”

Section: Discussionmentioning

confidence: 99%

Effect of Vancomycin Therapy for Osteomyelitis on Colonization by Methicillin-ResistantStaphylococcus aureus: Lack of Emergence of Glycopeptide Resistance

Bernard

Vaudaux

Vuagnat

et al. 2003

Infect. Control Hosp. Epidemiol.

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BACKGROUND: In treating orthopedic infections, the long-term impact of vancomycin therapy on colonization by methicillin-resistant Staphylococcus aureus (MRSA) and the emergence of vancomycin-intermediate S. aureus is unknown.DESIGN: Prospective surveillance of the effect of longterm vancomycin therapy on colonization by MRSA and the emergence of vancomycin-intermediate S. aureus. METHODS: Thirty-four patients with MRSA osteomyelitis that was microbiologically documented were longitudinally observed for the emergence of vancomycin-intermediate S. aureus at 3 body sites (wound, anterior nares, and groin) during the initial period of vancomycin therapy and at the 2-month follow-up. Twenty patients received the standard dose (20 mg/kg/d) for 34 ± 6 days and 14 patients received a high dose (40 mg/kg/d) of vancomycin for 37 ± 9 days.RESULTS: During vancomycin treatment, global MRSA carriage (all body sites) fell from 100% to 25% in the group of patients receiving the standard dose of vancomycin, and from 100% to 40% in the group receiving the high dose. During the 2-month follow-up period after vancomycin therapy, global MRSA carriage increased from 25% to 55% in the group receiving the standard dose and decreased from 43% to 36% in the group receiving the high dose.CONCLUSION: Therapy with a high dose of vancomycin contributes to the sustained eradication of MRSA carriage without promoting the emergence of glycopeptide resistance (Infect Control Hosp Epidemiol 2003;24:650-654).

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Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics

Cited by 185 publications

References 22 publications

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

Effect of Vancomycin Therapy for Osteomyelitis on Colonization by Methicillin-ResistantStaphylococcus aureus: Lack of Emergence of Glycopeptide Resistance

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