Ointment reduces nosocomial infections
07/01/2002
By Mark A. DeSorbo
PHILADELPHIA- A New England Journal of Medicine study indicates that applying mupirocin ointment in the noses of patients before surgery significantly reduces the rate of staphylococcus aureus (S. aureus) nosocomial infections among patients who carry this bacteria.
The report, which was based on several years of research, was conducted at the University of Iowa Hospitals and Clinics. The efficacy of mupirocin nasal ointment, marketed as Bactroban(R) Nasal by GlaxoSmithKline (Philadelphia, PA), was evaluated at university facilities against placebo in patients undergoing general, neurosurgical or cardiothoracic operations.
"It's an interesting thought, and it would certainly help, but I'm sure the patient is not the major source of contamination," says Hank Rahe, a member of the of the CleanRooms Editorial Advisory Board, who often writes about infection control in hospital environments in the Life Sciences section of the magazine. "[Bacteria] is being tracked on the hands and feet of hospital workers, patients and kids visiting grandma or grandpa more than anything else. It sounds intriguing, but there's still a long way to go."
Authors of the report say staphylococcus aureus is a common cause of postoperative hospital-acquired infections. This type of bacteria is carried in the noses of 25 to 30 percent of healthy individuals, and patients who are carriers of the bacteria are at higher risk of acquiring S. aureus infections after invasive medical or surgical procedures than individuals who do not carry the organism.
"The study is the first large, well-controlled, double-blinded trial in surgical patients to show that mupirocin nasal ointment had a protective effect in people who are nasal carriers of S. aureus," says Dr. Pamela P. French, a co-author for the study. "This is an important finding because while the incidence of postoperative infection may be relatively low, the impact of S. aureus infections in people recovering from major surgery can be catastrophic."
The U.S. Centers for Disease Control and Prevention (Atlanta, GA) reports that hospital-acquired infections kill 90,000 people and costs $4.5 billion each year.
The double blind, placebo-controlled study evaluated 3,864 adults undergoing general, gynecologic, cardiothoracic and neurosurgical operations. Placebo was applied to the interior of the nose twice daily for up to five days prior to surgery. In addition, surgeons followed standard clinical practices and used standard prophylactic antimicrobial regimens.
The study evaluated the effect of treatment on patients regardless of whether they carried S. aureus and separately examined the results among the subgroup of individuals known to carry the organism.
Study results showed:
- Mupirocin nasal ointment pre-surgical treatment significantly reduced the rate of postoperative S. aureus nosocomial infections in patients who were S. aureus nasal carriers.
- S. aureus carriage was eliminated in 83.4 percent of the mupirocin-treated group versus 27.4 percent of placebo-treated patients.
- Mupirocin nasal ointment significantly decreased the rate of S. aureus nosocomial infections among nasal carriers, the group expected to be at risk.
- S. aureus surgical site infections were reduced by almost 50 percent among people who were S. aureus carriers who received mupirocin nasal ointment before cardiothoracic or general surgery procedures versus a similar group of placebo treated individuals.
- The rates of side effects with mupirocin nasal ointment in the study were low and similar to placebo (4.8 percent reported per study group). The most commonly reported side effects in both groups were runny nose and itching at the application site.
It was also determined through microbial testing that a single short course of mupirocin nasal ointment for preoperative prophylaxis did not appear to lead to the development of drug resistance.
"Mupirocin therapy is safe, has a protective effect among nasal carriers of S. aureus, and is a reasonable, adjuvant agent to prevent such infections in carriers after surgery," study authors conclude.