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JAC Advance Access originally published online on January 3, 2008
Journal of Antimicrobial Chemotherapy 2008 61(2):254-261; doi:10.1093/jac/dkm480
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Systematic review

Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review

Miranda M. L. van Rijen1,*, Marc Bonten2, Richard P. Wenzel3 and Jan A. J. W. Kluytmans1,4

1 Laboratory for Microbiology and Infection Control, Amphia Hospital, Location Molengracht, PO Box 90158, 4800 RK Breda, The Netherlands 2 Department of Internal Medicine, Division of General Medicine and Infectious Diseases, Julius Center for Health Sciences and Primary Care, Department of Hospital Hygiene and Infection Prevention, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands 3 Department of Internal Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, 1220 E. Clay St, Richmond, VA 23284, USA 4 Department of Medical Microbiology and Infection Control, VUmc Medical University, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands

Received 4 October 2007; returned 31 October 2007; revised 12 November 2007; accepted 18 November 2007

* Corresponding author. Laboratory for Microbiology and Infection Control, Amphia Hospital, Location Langendijk, PO Box 90157, 4800 RL Breda, The Netherlands. Tel: +31-76-5954289; Fax: +31-76-5952053; E-mail: mvrijen{at}amphia.nl

Objectives: The majority of nosocomial Staphylococcus aureus infections originate from the patients’ own flora, with nasal carriage of S. aureus before surgical procedures being a risk factor for subsequent infection. The objective of this review was to assess whether intranasal mupirocin treatment of nasal S. aureus carriers before surgery results in a reduction of the post-operative S. aureus infection rate.

Methods: CENTRAL, EMBASE and MEDLINE were searched for the keywords mupirocin, pseudomonic acid or bactroban, combined with nasal or intranasal. Only randomized controlled studies investigating surgical patients were included. Titles and abstracts were screened independently by two reviewers. S. aureus infection data in nasal carriers with and without mupirocin treatment were pooled in the meta-analysis.

Results: The literature search resulted in 211 hits, of which 4 articles met the inclusion criteria. Among the 686 mupirocin-treated surgical patients with S. aureus nasal carriage, there were 25 S. aureus infections (3.6%), compared with 46 (6.7%) in the controls (RR 0.55, 95% CI 0.34–0.89; P = 0.02).

Conclusions: Prophylactic intranasal mupirocin significantly reduced the rate of post-operative S. aureus infections among surgical patients who were S. aureus carriers.

Keywords: carrier , pre-operative , surgery


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