Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery

Suzuki, Yutaka; Kamigaki, Takashi; Fujino, Y.; Tominaga, Masahiro; Ku, Yonson; Kuroda, Yasuhiro

doi:10.1002/bjs.4269

Cited by 43 publications

(31 citation statements)

References 12 publications

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“…For example, Gernaat-van der Sluis et al [5] reported prophylactic mupirocin reduced the overall SSI rate after orthopaedic surgery among S. aureus carriers (1.3% versus 2.7%), but not the rate among those with S. aureus SSIs (0.7% versus 1.1%). In contrast, randomized studies often failed to detect substantial differences favoring mupirocin in patients undergoing orthopaedic [9], cardiac [14], gastrointestinal [26], or mixed surgery [21]. Unexpected findings may have played a role, such as a lower-than-expected rate of S. aureus SSI in control groups, confounding the ability to detect differences within the sample size [9,14].…”

Section: Discussionmentioning

confidence: 99%

“…Konvalinka et al [14] reported nasal S. aureus colonization disappeared in almost half of control patients, further obscuring the anticipated benefit of mupirocin. The lack of benefit after gastrointestinal surgery is not surprising in view of the high percentage of Gram-negative infections; however, mupirocin was associated with less S. aureus pneumonia (none versus 2%) [26]. Perl et al [21] reported mupirocin did not reduce S. aureus SSIs after mixed surgery (2.3% versus 2.4%) but reduced S. aureus nosocomial infections in the subset of S. aureus nasal carriers (4.0% versus 7.7%).…”

Section: Discussionmentioning

confidence: 99%

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A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

Rao

Cannella

Crossett

et al. 2008

Clinical Orthopaedics &Amp; Related Research

178

118

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Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

Rao

Cannella

Crossett

et al. 2008

Clinical Orthopaedics &Amp; Related Research

178

118

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“…It is concluded that MRSA eradication is a good preventative method, but should be utilised alongside regular surveillance to ensure MRSA infections are controlled [16]. Suzuki et al, described a significant reduction in chest infections without significant reduction in SSI with no reduction in rates of nosocomial MRSA SSI infections in abdominal digestive surgery [17].…”

Section: Discussionmentioning

confidence: 99%

Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery

Singh¹

2017

IJCTS

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Abstract:The problem of methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and decolonisation strategies. Cardiac surgery unit admissions receive MRSA cultures from nares, skin, throat and wounds/groin, and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed. The study comprises 50 patients: 32 successfully decolonized/eradicated carriers and 18 unsuccessfully eradicated carriers. A comparison of preoperative characteristics showed no statistically significant differences between the 2 groups with the exception for asthmatic patients, where there was only 3.1% of MRSA eradicated patients vs 22.2% in the unsuccessful eradication group (p=0.031). There was no difference between the operative patient data of both groups in hospital mortality, post-operative lengths of stay, ventilation time, post op IABP (intra-aortic balloon pump), post-operative complications, Cerebrovascular accidents and Transient Ischaemic attacks as well as long term complications were not statistically significant. However, there is a statistically significant difference between the use of post-operative antibiotics, with 72.2% of unsuccessfully MRSA eradicated patients requiring antibiotics postoperatively, compared to 40.6%, (p=0.032). Preoperative asthmatics were more likely to fail MRSA eradication/decolonisation. Post operatively MRSA eradication results in the reduction in postoperative antibiotic use.

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“…Four of these were randomized trials [14,15,21,24] including 3 placebo-controlled trials [14,21,24] . Seven studies were open cohort ('before/after') studies [16][17][18][19][20][21][22][23] .…”

Section: Reduction In All Ssismentioning

confidence: 99%

“…In 8 studies, treatment with mupirocin was started 1-7 days before the planned surgical procedure [14][15][16][17][18][19][20][21] . Two studies started mupirocin on the day of surgery and extended the application for 4-7 days after surgery in swab-positive patients [22,23] .…”

Section: Application Of Mupirocinmentioning

confidence: 99%

Intranasal Mupirocin Prophylaxis in Elective Surgery

Trautmann

Stecher

Hemmer³

et al. 2007

Chemotherapy

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Background: Mupirocin is a natural antibiotic from Pseudomonas fluorescens which is available as a 2% ointment. The drug has been used mainly for topical treatment of the nasal vestibulum in patients carrying methicillin-resistant Staphylococcus aureus (MRSA). However, mupirocin is also active against methicillin-sensitive S. aureus. Nasal colonization with S. aureus has been identified as a significant risk factor for surgical site infection (SSI). Methods: Randomized trials and sequential cohort studies investigating mupirocin nasal treatment for prophylaxis of SSI in elective surgery in comparison with placebo or no treatment were found by Medline review and additional manual search. Evaluable studies were analyzed regarding the influence of mupirocin on the rate of all SSIs and, specifically, of SSIs due to S. aureus. The effect in cardiosurgical patients was analyzed in detail. Results: Four randomized and seven sequential open cohort studies were analyzed. Study design and mupirocin application schemes varied considerably. Three out of 5 studies carried out in cardiac surgery patients showed a significant reduction in sternotomy site infections. However, all three studies were open sequential cohort studies. By contrast, the only prospective, randomized, double-blind study in cardiosurgical patients showed no benefit of mupirocin. In other surgical disciplines, results were inconclusive or negative. Two studies specifically addressing the prevention of SSIs due to MRSA showed a significant effect of mupirocin on postsurgical infections due to this organism. Conclusions: Because of the heterogeneity of the studies and the variability of results, no recommendation can be given for the general use of mupirocin in elective surgical patients. Specifically, because of the negative result of a recently published high-quality study, no recommendation can be made for the use of mupirocin in cardiosurgical patients. By contrast, eradication of MRSA before surgery appears to lower SSI rates due to MRSA and is therefore recommended.

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Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery

Abstract: Intranasal mupirocin treatment had no significant impact on surgical-site infection after digestive surgery.

Cited by 43 publications

References 12 publications

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections

Methicillin Resistant Staphylococcus Aureus (MRSA) Eradication Prior to Cardiac Surgery

Intranasal Mupirocin Prophylaxis in Elective Surgery

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