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Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study

Heiman F L Wertheim1, Margreet C Vos, Alewijn Ott

  • 1Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. h.wertheim@erasmusmc.nl

Annals of Internal Medicine
|March 17, 2004
PubMed
Abstract

Insights

Routine screening for Staphylococcus aureus nasal carriage and mupirocin prophylaxis are not effective in preventing nosocomial infections in nonsurgical patients. This study found no significant difference in infection rates between mupirocin and placebo groups.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Antimicrobial Stewardship

Background:

  • Staphylococcus aureus nasal carriage is a significant risk factor for developing nosocomial S. aureus infections.
  • Intranasal mupirocin has demonstrated efficacy in preventing surgical site infections, but its effectiveness in nonsurgical patients remains unexamined.

Purpose of the Study:

  • To evaluate the efficacy of mupirocin prophylaxis in preventing nosocomial Staphylococcus aureus infections among hospitalized nonsurgical patients.

Main Methods:

  • A randomized, double-blind, placebo-controlled trial was conducted across four hospitals.
  • 1602 patients with S. aureus nasal carriage in nonsurgical departments received either mupirocin or placebo nasal ointment for five days.
  • Outcomes included nosocomial S. aureus infections, mortality, hospitalization duration, and time to infection, with genotyping to identify endogenous strains.

Main Results:

  • No statistically significant difference was observed in nosocomial S. aureus infection rates (2.6% vs. 2.8%) or mortality between the mupirocin and placebo groups.
  • Hospitalization duration was similar (median 8 days) for both groups.
  • While not statistically significant (P > 0.2), the time to nosocomial S. aureus infection appeared to decrease in the mupirocin group (from 12 to 25 days).

Conclusions:

  • Routine screening for S. aureus nasal carriage and subsequent mupirocin application is not an effective prophylactic strategy for preventing nosocomial S. aureus infections in nonsurgical patients.
  • A limitation included potential missed infections due to assessment criteria based solely on positive microbiology results.

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