Yoav Golan, MD
Does rapid identification of nasal carriers of Staphylococcus aureus and immediate decolonization of the nostrils and skin prevent hospital-associated infection with S. aureus?
Randomized placebo-controlled trial. Current Controlled Trials ISRCTN56186788.
Blinded (patients, clinicians, data collectors, and laboratory personnel).*
6 weeks after hospital discharge.
Surgical and internal medicine wards in 3 university hospitals and 2 general hospitals in the Netherlands.
918 adults (mean age 62 y, 63% men, 88% surgical) who were positive on rapid screening (by real-time polymerase chain reaction [PCR]) for nasal carriage of S. aureus at hospital admission and were expected to be in hospital ≥ 4 days. Exclusion criteria included active infection with S. aureus, pregnancy, and use of mupirocin in ≤ 4 weeks.
Starting within 24 hours of admission, mupirocin ointment 2% intranasally twice daily and a daily bath with chlorhexidine gluconate soap, 40 mg/mL (n = 505), or double placebo (n = 413) for 5 days.
Cumulative incidence of hospital-associated S. aureus infection, time to infection, duration of hospitalization, and in-hospital mortality.
99.9% (intention-to-treat analysis).
19% of patients screened had a positive result. Patients in the intervention group had a lower incidence of hospital-associated S. aureus infection (Table). Treatment was effective in preventing deep, but not superficial, surgical site infection (Table). Time to infection was longer in the intervention group (P = 0.005), and mean duration of hospitalization was shorter (12 vs 14 d, P = 0.04). Groups did not differ for in-hospital mortality (2.6% vs 3.1%; relative risk 0.82, 95% CI 0.37 to 1.8).
In nasal carriers of Staphylococcus aureus admitted to hospital, decolonization of the nostrils with mupirocin ointment and of the skin with chlorhexidine soap prevented hospital-associated infection with S. aureus.
Mupirocin nasal ointment plus chlorhexidine soap (intervention) vs placebo for preventing hospital-associated infection with Staphylococcus aureus in nasal carriers of S. aureus†
†Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
‡Assessed in surgical patients only (88% of patients).
Golan Y. Decolonization of nostrils and skin of nasal carriers of S. aureus at admission prevented hospital-associated infection. Ann Intern Med. 2010;152:JC5–9. doi: 10.7326/0003-4819-152-10-201005180-02009
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Published: Ann Intern Med. 2010;152(10):JC5-9.
Hospital Medicine, Infectious Disease, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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