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Mupirocin Prophylaxis against Nosocomial Staphylococcus aureus Infections in Nonsurgical Patients: A Randomized Study

Heiman F.L. Wertheim, MD, MSc; Margreet C. Vos, MD, PhD; Alewijn Ott, MD, PhD; Andreas Voss, MD, PhD; Jan A.J.W. Kluytmans, MD, PhD; Christina M.J.E. Vandenbroucke-Grauls, MD, PhD; Marlene H.M. Meester, ICP; Peter H.J. van Keulen, MD; and Henri A. Verbrugh, MD, PhD
[+] Article and Author Information

From Erasmus University Medical Center, Rotterdam, the Netherlands; University Medical Center St. Radboud, Nijmegen, the Netherlands; Amphia Hospital, Breda, the Netherlands; and VU University Medical Center, Amsterdam, the Netherlands.


Acknowledgments: The authors thank all the patients who participated in this study and the following people who have made this study possible: Annie Antonissen; Myra Behrendt; Alex van Belkum; Hélène Boelens; Wilma Kraak; Jan Nouwen; Gerard Parlevliet; Cindy van Pelt; Geert van de Sanden; Melanie Srodzinsky; Roel Verkooyen; Laura Verputten; Arjen van Vliet; Joke van Wegen; and the technicians and infection control nurses at Erasmus Medical Center, Amphia Hospital, University Medical Center St. Radboud, and VU Medical Center.

Grant Support: By Zon-Mw, The Netherlands Organization for Health Research and Development.

Potential Financial Conflicts of Interest:Grants received: J.A.J.W. Kluytmans (GlaxoSmithKline).

Requests for Single Reprint: Heiman F.L. Wertheim, MD, MSc, Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e-mail, h.wertheim@erasmusmc.nl.

Current Author Addresses: Drs. Wertheim, Vos, Ott, and Verbrugh: Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.

Dr. Voss: University Medical Center St. Radboud, Department of Medical Microbiology and Infectious Diseases, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, the Netherlands.

Drs. Kluytmans and van Keulen: Amphia Hospital Breda, Langendijk, Laboratory of Microbiology and Infection Control, PO Box 90158, 4800 RK Breda, the Netherlands.

Dr. Vandenbroucke-Grauls and Ms. Meester: Department of Medical Microbiology and Infection Prevention, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.

Author Contributions: Conception and design: H.F.L. Wertheim, M.C. Vos, A. Ott, A. Voss, J.A.J.W. Kluytmans, C.M.J.E. Vandenbroucke-Grauls, P.H.J. van Keulen, H.A. Verbrugh.

Analysis and interpretation of the data: H.F.L. Wertheim, M.C. Vos, A. Ott, A. Voss, J.A.J.W. Kluytmans, C.M.J.E. Vandenbroucke-Grauls, M.H.M. Meester, P.H.J. van Keulen, H.A. Verbrugh.

Drafting of the article: H.F.L. Wertheim, M.C. Vos, A. Ott, H.A. Verbrugh.

Critical revision of the article for important intellectual content: M.C. Vos, A. Ott, A. Voss, J.A.J.W. Kluytmans, C.M.J.E. Vandenbroucke-Grauls, M.H.M. Meester, P.H.J. van Keulen, H.A. Verbrugh.

Final approval of the article: H.F.L. Wertheim, M.C. Vos, A. Ott, A. Voss, C.M.J.E. Vandenbroucke-Grauls, P.H.J. van Keulen, H.A. Verbrugh.

Provision of study materials or patients: H.F.L. Wertheim, J.A.J.W. Kluytmans, C.M.J.E. Vandenbroucke-Grauls, M.H.M. Meester, P.H.J. van Keulen.

Statistical expertise: H.F.L. Wertheim, A. Ott, J.A.J.W. Kluytmans.

Obtaining of funding: M.C. Vos, J.A.J.W. Kluytmans, P.H.J. van Keulen, H.A. Verbrugh.

Administrative, technical, or logistic support: H.F.L. Wertheim, J.A.J.W. Kluytmans, P.H.J. van Keulen.

Collection and assembly of data: H.F.L. Wertheim, A. Voss, J.A.J.W. Kluytmans, M.H.M. Meester, P.H.J. van Keulen.


Ann Intern Med. 2004;140(6):419-425. doi:10.7326/0003-4819-140-6-200403160-00007
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This study showed that screening for S. aureus nasal carriage on admission by routine culture and applying mupirocin in S. aureus carriers to prevent nosocomial S. aureus infections in nonsurgical patients is not an efficacious strategy. None of the risk differences for the different types of nosocomial infections and mortality indicated sufficient mupirocin effectiveness to merit treatment (risk difference for overall infection, 0.2 percentage point [CI, −1.5 to 1.9 percentage points]; risk difference for mortality, −0.2 percentage point [CI, −1.9 to 1.5 percentage points]; P> 0.05). We found that 82.4% of the bacteremic strains were clonally related to the nasal strain at admission, which confirms the results found by von Eiff and colleagues (7).

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Summary for Patients

Effects of Antibiotic Nose Ointment for Hospitalized Patients with Staphylococcus aureus

The summary below is from the full report titled “Mupirocin Prophylaxis against Nosocomial Staphylococcus aureus Infections in Nonsurgical Patients. A Randomized Study.” It is in the 16 March 2004 issue of Annals of Internal Medicine (volume 140, pages 419-425). The authors are H.F.L. Wertheim, M.C. Vos, A. Ott, A. Voss, J.A.J.W. Kluytmans, C.M.J.E. Vandenbroucke-Grauls, M.H.M. Meester, P.H.J. van Keulen, and H.A. Verbrugh.

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