Mupirocin-based nasal decolonization to prevent Staphylococcus aureus surgical site infections: A meta-analysis of...

To determine whether mupirocin-based decolonization, compared with placebo, no treatment, or alternative agents, reduces Staphylococcus aureus-related surgical site infection (SA-SSI), nasal S. aureus colonization, and overall SSIs incidence in elective surgery.

We searched EMBASE, Medline (Ovid), PubMed, CENTRAL, and Google Scholar to May 15, 2024, for randomized controlled trials (RCTs). Risk ratios (RRs) were pooled using a random-effects model with the restricted maximum likelihood estimator with the Hartung-Knapp adjustment. Prespecified subgroup analyses evaluated application strategy, surgical type, and chlorhexidine gluconate (CHG) co-administration.

Seventeen RCTs (15,533 participants) were included. In trials with no-treatment or placebo controls, mupirocin-based decolonization reduced SA-SSI (RR 0.67, 95% confidence interval (CI) 0.49-0.91) and nasal colonization (RR 0.22, 95% CI 0.18-0.26). Effects were larger with targeted use in confirmed carriers and when combined with CHG. No reduction was observed for overall SSIs, except in orthopedic surgery (RR 0.80, 95% CI 0.65-0.99). Head-to-head data vs active alternatives were sparse and did not show a consistent advantage for mupirocin.

Targeted preoperative mupirocin, especially when combined with CHG, reduces SA-SSI in elective surgery. The lack of significant impact on overall SSIs is interpreted as a reflection of polymicrobial etiologies in surgical infections. Given the emerging risk of mupirocin resistance, further adequately powered head-to-head trials with standardized outcomes and integrated resistance surveillance are warranted.