Intranasal Mupirocin to Prevent Postoperative Staphylococcus Aureus Infections

Background

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.

Methods

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.

Results

Of 4030 enrolled patients who underwent general, gynecologic, neurologic, or cardiothoracic surgery, 3864 were included in the intention-to-treat analysis. Overall, 2.3% of mupirocin recipients and 2.4% of placebo recipients had S. aureus infections at surgical sites. Of the 891 (23.1% 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% of those who received mupirocin had nosocomial S. aureus infections as compared with 7.7% of those who received placebo (odds ratio for infection, 0.49; 95% confidence interval, 0.25–0.92; P = 0.02).

Conclusions

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.