Nasal decolonization: What antimicrobials are most effective prior to surgery?

Surgical site infection (SSI) is one of the most common health care-associated infections. Staphylococcus aureus remains the most common etiologic agent causing SSIs. Studies confirm S aureus carriage increases the risk of S aureus SSIs. The purpose of this article is to review the strategies to reduce SSIs due to S aureus focusing on nasal decolonization.

Published studies indicate screening patients for S aureus nasal carriage and decolonizing carriers during the preoperative period decreases the risk of S aureus SSIs in cardiac and orthopedic surgery. Mupirocin remains the best topical agent at eradicating nasal S aureus however, concerns over resistance have led to development of alternative agents. Nasal povidone-iodine, alcohol-based nasal antiseptic, and photodynamic therapy are promising new interventions, but more studies are needed.

Short term nasal mupirocin is still the most studied and effective topical agent in eradicating S aureus nasal colonization. However, increasing mupirocin resistance remains an ongoing concern and newer agents are needed. Currently, preoperative S aureus decolonization often uses combination chlorhexidine gluconate bathing and nasal mupirocin considering that colonization of multiple body sites is commonly seen.