2013-05-21T07:34:20Z http://repub.eur.nl/oai

oai:repub.eur.nl/res/pub/10321 2012-11-14T12:25:08Z org:9830 org:9755 org:9821 org:9746 access:open type:article

urn:NBN:nl:ui:15-1765/10321 2012-11-14T12:25:08 mods http://hdl.handle.net/1765/10321 hdl:1765/10321 urn:NBN:nl:ui:15-1765/10321 Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study text article http://hdl.handle.net/1765/10321 http://repub.eur.nl/res/pub/10321/15023707.pdf application/pdf Filesize: 148 KB born digital BACKGROUND: Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients. OBJECTIVE: To assess the efficacy of mupirocin prophylaxis in preventing nosocomial S. aureus infections in nonsurgical patients. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 3 tertiary care academic hospitals and 1 nonacademic hospital. PATIENTS: 1602 culture-proven S. aureus carriers hospitalized in nonsurgical departments. INTERVENTION: Therapy with mupirocin 2% nasal ointment (n = 793) or placebo ointment (n = 809), twice daily for 5 days, started 1 to 3 days after admission. MEASUREMENTS: Nosocomial S. aureus infections according to defined criteria, in-hospital mortality, duration of hospitalization, and time to nosocomial S. aureus infection. Staphylococcus aureus isolates were genotyped to assess whether infection was caused by endogenous strains. RESULTS: The mupirocin and placebo groups did not statistically differ in the rates of nosocomial S. aureus infections (mupirocin, 2.6%; placebo, 2.8%; risk difference, 0.2 percentage point [95% CI, -1.5 to 1.9 percentage points]), mortality (mupirocin, 3.0%; placebo, 2.8%; risk difference, -0.2 percentage point [CI, -1.9 to 1.5 percentage points]), or duration of hospitalization (median for both, 8 days). However, time to nosocomial S. aureus infection was decreased in the mupirocin group from 12 to 25 days (P > 0.2). A total of 77% of S. aureus nosocomial infections were endogenous. LIMITATIONS: A few infections in both groups may have been missed because investigators assessed a patient for infection only if microbiology culture results were positive for S. aureus. CONCLUSION: Routine culture for S. aureus nasal carriage at admission and subsequent mupirocin application does not provide effective prophylaxis against nosocomial S. aureus infections in nonsurgical patients. Vos, M.C. Vos Margreet aut Ott, A. Ott Alewijn aut Voss, A. Voss Andreas aut Kluytmans, J.A.J.W. Kluytmans J.A.J.W. aut Vandenbroucke-Grauls, C.M.J.E. Vandenbroucke-Grauls Christina aut Meester, M.H.M. Meester Marlene aut Keulen, P.H.J. van Keulen, van Peter aut Verbrugh, H.A. Verbrugh Henri aut Wertheim, H.F.L. Wertheim Heiman aut 10690308X 159213142 068402856 276955390 Erasmus MC: University Medical Center Rotterdam Supporting host sht en English Annals of Internal Medicine 0003-4819 2004-01-01 Male Female Humans Middle aged Research Support, Non-U.S. Gov't Treatment Outcome Genotype Nose/microbiology Double-Blind Method Length of Stay Ointments Carrier State/microbiology *Antibiotic Prophylaxis Administration, Intranasal Anti-Bacterial Agents/administration & dosage/*therapeutic use Cross Infection/*prevention & control Hospital Mortality Mupirocin/administration & dosage/*therapeutic use Staphylococcal Infections/*prevention & control Staphylococcus aureus/genetics/isolation & purification Erasmus University Rotterdam oai:repub.eur.nl/res/pub/10321 IR OAIPMH feed (http://repub.eur.nl/oai) 2007-06-19T14:48:12Z 2011-11-23T09:59:13Z http://purl.org/eprint/accessRights/OpenAccess