Mupirocin was used in haemodialysis patients in an attempt to eradicate nasal carriage of Staphylococcus aureus and to prevent infection caused by this microorganism. The effectiveness of calcium mupirocin as a 2% nasal ointment OB2 (16 patients for 104 patient-months) was compared to that of placebo (18 patients for 147 patient-months) in a double-blind study. Mupirocin or placebo were applied in both anterior nares thrice daily for 2 weeks and subsequently three times weekly for a total of 9 months. During therapy, S. aureus was recovered from only 6% of the nasal cultures in the mupirocin group compared to 58% in the placebo group (P less than or equal to 0.01). Only one S. aureus infection was documented in the mupirocin group compared to six in the placebo group (P less than or equal to 0.05). The S. aureus strain causing the single infection in the mupirocin group was of a different phage type to that of the original nasal strain. In contrast, at least four of the six strains causing infection in the placebo group were of similar phage type to the original nasal strain. All S. aureus isolates remained mupirocin sensitive (MIC less than or equal to 1 mg/l). In conclusion, mupirocin nasal ointment was effective in eradicating nasal carriage of S. aureus and in preventing S. aureus infections in patients on haemodialysis.

Nasal carriage of Staphylococcus aureus is a risk factor for the development of infections caused by S. aureus in haemodialysis patients. This study compared the incidence of bacteraemia caused by S. aureus during 6 months of use of nasal 2% calcium mupirocin ('Nasal Bactroban') 3-times a week for nasal carriers with the incidence observed previously in the same dialysis unit without the use of mupirocin. Nasal mupirocin led to the total eradication of nasal carriage of S. aureus, a 4.26-fold reduction in the incidence of S. aureus bacteraemia, and a substantial cost saving. After a cumulative experience of nasal mupirocin in haemodialysis patients of more than 43 patient-years, the development of mupirocin resistance was not observed.

Fifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P < .001). Eighty-seven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.

Fifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P < .001). Eighty-seven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.

Fifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P<.001). Eightyseven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.