Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Abstract

Background Treatment of Staphylococcus aureus colonization prior to surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone iodine solution may provide an alternative to mupirocin. Methods We conducted an investigator initiated, open label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical 2% chlorhexidine gluconate (CHG) wipes with either twice daily application of mupirocin 2% ointment for the 5 days prior to surgery or two 30 second applications of povidone iodine 5% solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery caused by any pathogen or S. aureus. Results In the intent-to-treat analysis, a deep SSI developed after 14 of 855 surgeries in the mupirocin group and 6 of 842 surgeries in the povidone iodine group; S. aureus deep SSI developed after 5 surgeries in the mupirocin group and 1 surgery in the povidone iodine group. In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgeries in the mupirocin group and 0 of 776 surgeries in the povidone iodine group. Patients found to be S. aureus colonized before surgery were more likely to have a S. aureus deep SSI (OR 6.79; 95% CI 1.1–41.2; p=0.02). Conclusions Nasal povidone iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.

Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares

“…This is consistent with a recent report of a prospective, open-label, randomized clinical trial where bacterial reduction with 3M SNP resulted in significantly fewer S. aureus SSIs than in mupirocin-treated patients (twice daily for 5 days) undergoing primary or revision arthroplasty or spinal fusion (37).…”

“…Recently, Phillips et al conducted a prospective, open-label, randomized clinical study to evaluate 3M SNP as an alternative to intranasal mupirocin because of lack of patient compliance and increasing mupirocin resistance (37). They demonstrated that 3M SNP resulted in significantly fewer S. aureus SSIs than mupirocin.…”

Decolonization in Prevention of Health Care-Associated Infections

“…Second, the authors could not perform multivariate analysis due to the small sample size. Third, patients were not followed after discharge to identify late infections (84).…”

Antibiotics and antiseptics for preventing infection in people receiving revision total hip and knee prostheses: a systematic review of randomized controlled trials

“…Five RCTs met the inclusion criteria for the review [33–37]. Two authors were contacted to clarify questions on study design [33] and the breakout of infections by revision THA/TKA [37].…”