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Reduction in Staphylococcus aureus wound colonization using nasal mupirocin and selective decontamination of the
D P Mackie1, W A van Hertum, T H Schumburg
1Rode Kruis Ziekenhuis, Anaesthesiology Department, Beverwijk, The Netherlands.
Abstract:
Following the introduction in 1988 of a regimen of selective decontamination of the digestive tract (SDD) for extensively injured patients in our burns centre, colonization rates with Gram-negative organisms declined significantly, but colonization with Staphylococcus aureus was unaffected. In an effort to reduce staphylococcal colonization, the SDD regimen has been supplemented with intranasal mupirocin since 1991. In this paper, 33 consecutive patients with burns of > 30 per cent TBSA who were treated with the supplemental regimen (SDD + M) in 1991 and 1992, were compared with 34 consecutive patients admitted in the previous 2 years who were treated with SDD only. Staph. aureus colonization of wounds, sputum and gastric aspirates was significantly reduced in the SDD + M group. Gram-negative colonization rates and the incidence of clinical infections remained low in both groups. Our experience suggests that decontamination of endogenous bacterial reservoirs, in combination with isolation measures to prevent exogenous colonization, effectively prevents infectious complications in patients with severe burns.
Insights
Selective decontamination of the digestive tract (SDD) with intranasal mupirocin significantly reduced Staphylococcus aureus colonization in severe burn patients. This combined approach effectively prevents infectious complications, maintaining low Gram-negative colonization rates.
Area of Science:
- Infection Control
- Critical Care Medicine
- Microbiology
Background:
- Selective Decontamination of the Digestive Tract (SDD) reduced Gram-negative colonization in burn patients since 1988.
- However, Staphylococcus aureus colonization remained unaffected by the initial SDD regimen.
- Intranasal mupirocin was added to SDD in 1991 to address S. aureus.
Purpose of the Study:
- To evaluate the efficacy of supplemental intranasal mupirocin combined with SDD (SDD + M) in reducing staphylococcal colonization.
- To compare infection rates in patients treated with SDD + M versus SDD alone.
Main Methods:
- Retrospective comparison of 33 consecutive burn patients (>30% TBSA) treated with SDD + M (1991-1992).
- Comparison group: 34 consecutive burn patients treated with SDD only (previous 2 years).
- Assessed colonization rates of wounds, sputum, and gastric aspirates for S. aureus and Gram-negative organisms.
Main Results:
- SDD + M significantly reduced S. aureus colonization in wounds, sputum, and gastric aspirates.
- Gram-negative organism colonization rates remained low in both SDD and SDD + M groups.
- The incidence of clinical infections was low in both treatment groups.
Conclusions:
- Combining SDD with intranasal mupirocin is effective in reducing S. aureus colonization in severe burn patients.
- Decontamination of endogenous reservoirs, coupled with isolation, effectively prevents infectious complications in severe burns.
- This strategy supports improved infection control in high-risk burn populations.