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Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Published online by Cambridge University Press:  10 May 2016

Michael Phillips ,
Andrew Rosenberg ,
Bo Shopsin ,
Germaine Cuff ,
Faith Skeete ,
Alycia Foti ,
Kandy Kraemer ,
Kenneth Inglima ,
Robert Press  and
Joseph Bosco
Michael Phillips*
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Andrew Rosenberg
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Bo Shopsin
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Germaine Cuff
Affiliation:
New York University School of Medicine, New York, New York
Faith Skeete
Affiliation:
New York University Hospital Center, New York, New York
Alycia Foti
Affiliation:
New York University Hospital Center, New York, New York
Kandy Kraemer
Affiliation:
New York University Hospital Center, New York, New York
Kenneth Inglima
Affiliation:
New York University Hospital Center, New York, New York
Robert Press
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Joseph Bosco
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
*
New York University Langone Medical Center, Greenberg Hall, 545 First Avenue, New York, NY 10016 ([email protected]).
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Extract

Background

Treatment of Staphylococcus aureus colonization before surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone-iodine solution may provide an alternative to mupirocin.

Methods

We conducted an investigator-initiated, open-label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical chlorhexidine wipes in combination with either twice daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidone-iodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery.

Results

In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P = .1); S. aureus deep SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidone-iodine group (P = .2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P = .03).

Conclusions

Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.

Trial registration

ClinicalTrials.gov identifier: NCT01313182.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 826 - 832
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Klevens, RM, Edwards, JR, Richards, CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166.CrossRefGoogle ScholarPubMed
2. Renaud, A, Lavigne, M, Vendittoli, PA. Periprosthetic joint infections at a teaching hospital in 1990–2007. Can J Surg 2012;55(6):394–400.CrossRefGoogle Scholar
3. Kurtz, SM, Lau, E, Ong, KL, et al. Infection risk for primary and revision instrumented lumbar spine fusion in the Medicare population. J Neurosurg Spine 2012;17(4):342–347.CrossRefGoogle ScholarPubMed
4. Kurtz, SM, Lau, E, Watson, H, et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012;27(8 suppl):61–65, e1.CrossRefGoogle ScholarPubMed
5. Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus . N Engl J Med 2010;362(1):9–17.Google Scholar
6. Ramos, N, Skeete, F, Haas, JP, et al. Surgical site infection prevention initiative: patient attitude and compliance. Bull NYU Hosp Jt Dis 2011;69(4):312–315.Google Scholar
7. Cookson, B, Farrelly, H, Palepou, MF, et al. Mupirocin-resistant Staphylococcus aureus . Lancet 1992;339(8793):625.CrossRefGoogle ScholarPubMed
8. Annigeri, R, Conly, J, Vas, S, et al. Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin prophylaxis to prevent exit-site infection. Perit Dial Int 2001;21(6):554–559.CrossRefGoogle ScholarPubMed
9. McNeil, JC, Hulton, KG, Kaplan, SL, Mason, EQ. Mupirocin resistance in Staphylococcus aureus causing recurrent skin and soft tissue infections in children. Antimicrob Agents Chemother 2011;55(5):2431–2433.Google Scholar
10. Bathoorn, E, Hetem, DJ, Alphenaar, J, Kusters, JG, Bonten, MJ. Emergence of high-level mupirocin resistance in coagulase-negative staphylococci associated with increased short-term mupirocin use. J Clin Microbiol 2012;50(9):2947–2950.CrossRefGoogle ScholarPubMed
11. Layton, MC, Perez, M, Heald, P, Patterson, JE. An outbreak of mupirocin-resistant Staphylococcus aureus on a dermatology ward associated with an environmental reservoir. Infect Control Hosp Epidemiol 1993;14(7):369–375.Google Scholar
12. Jayakumar, S, Meerabai, M, Shameem Banu, AS, Renu, M, Kalyani, M, Binesh Lal, Y. Prevalence of high and low level mupirocin resistance among staphylococcal isolates from skin infection in a tertiary care hospital. J Clin Diagn Res 2013;7(2):238–242.Google Scholar
13. Hill, RL, Casewell, MW. The in-vitro activity of povidone-iodinecream against Staphylococcus aureus and its bioavailability in nasal secretions. J Hosp Infect 2000;45(3):198–205.Google Scholar
14. Shopsin, B, Gomez, M, Montgomery, SO, et al. Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol 1999;37(11):3556–3563.Google Scholar
15. Hallin, M, Deplano, A, Denis, O, De Mendonça, R, De Ryck, R, Struelens, MJ. Validation of pulsed-field gel electrophoresis and spa typing for long-term, nationwide epidemiological surveillance studies of Staphylococcus aureus infections. J Clin Microbiol 2007;45(1):127–133.CrossRefGoogle ScholarPubMed
16. Hallin, M, Friedrich, AW, Struelens, MJ. spa typing for epidemiological surveillance of Staphylococcus aureus . Methods Mol Biol 2009;551:189–202.CrossRefGoogle ScholarPubMed
17. Eltringham, I. Mupirocin resistance and methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect 1997;35(1):1–8.Google Scholar
18. Slover, J, Haas, JP, Quirno, M, Phillips, MS, Bosco, JA 3rd. Cost-effectiveness of a Staphylococcus aureus screening and decolonization program for high-risk orthopedic patients. J Arthroplasty 2011;26(3):360–365.Google Scholar
19. VandenBergh, MF, Kluytmans, JA, van Hout, BA, et al. Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. Infect Control Hosp Epidemiol 1996;17(12):786–792.CrossRefGoogle ScholarPubMed
20. Young, LS, Winston, LG. Preoperative use of mupirocin for the prevention of healthcare-associated Staphylococcus aureus infections: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2006;27(12):1304–1312.Google Scholar
21. Courville, XF, Tomek, IM, Kirkland, KB, Birhle, M, Kantor, SR, Finlayson, SR. Cost-effectiveness of preoperative nasal mupirocin treatment in preventing surgical site infection in patients undergoing total hip and knee arthroplasty: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2012;33(2):152–159.Google Scholar
22. Porter, ME. What is value in health care? N Engl J Med 2010;363(26):2477–2481.CrossRefGoogle ScholarPubMed
23. Enquist, M, Bosco, JA 3rd, Pazand, L, Habibi, KA, Donoghue, RJ, Zuckerman, JD. Managing episodes of care: strategies for orthopaedic surgeons in the era of reform. J Bone Joint Surg Am 2011;93(10):e55.Google Scholar
24. Matheson, A, Christie, P, Stari, T, Kavanagh, K, Gould, IM, Masterton, R, Reilly, JS. Nasal swab screening for methicillin-resistant Staphylococcus aureus: how well does it perform? a cross-sectional study . Infect Control Hosp Epidemiol 2012;33(8):803–808.Google Scholar
25. Senn, L, Basset, P, Nahimana, I, Zanetti, G, Blanc, DS. Which anatomical sites should be sampled for screening of methicillin-resistant Staphylococcus aureus carriage by culture or by rapid PCR test? Clin Microbiol Infect 2012;18(2):E31–E3.CrossRefGoogle ScholarPubMed