Mupirocin Group Research Articles

447: EFFICACY OF NASAL DECONTAMINATION WITH POVIDONE-IODINE COMPARED TO MUPIROCIN IN CARDIAC SURGERY

Introduction: Surgical site infections (SSIs) are considered the most common and costly healthcare-associated infection; coronary artery bypass graft (CABG) surgeries have the second highest cumulative incidence. Mupirocin is considered the gold standard intranasal decontamination treatment; however, povidone-iodine has emerged as an alternative. The objective of this study is to determine if universal nasal decontamination with povidone-iodine is as effective as targeted mupirocin in the prevention of SSIs in cardiac surgery patients. Methods: A single-center, retrospective, pre/post intervention analysis was conducted on adult patients admitted to Prisma Health–Upstate January 2017 to December 2021. Included patients received cardiac surgery for CABG and preoperative nasal decontamination with mupirocin (January 2017-December 2018) or povidone-iodine (January 2019-December 2021). The primary outcome assessed was SSI incidence. Secondary outcomes included S. aureus SSIs, non-surgical site S. aureus infection, in-hospital and 30-day mortality, hospital, and intensive care unit (ICU) length of stay (LOS), and cost. Results: Five hundred patients were screened, and 237 patients met inclusion criteria. Included patients were grouped into those receiving mupirocin (N=70) and povidone-iodine (N=167). Significant differences in baseline characteristics included the number of males and composite of past medical history. There was no difference in incidence of SSIs identified between the povidone-iodine and mupirocin (6 versus 3, p=0.726), even when stratified by SSI type (p=0.786). No differences were identified in any of the secondary outcomes between the povidone-iodine and mupirocin groups; however, evaluation of the safety outcome revealed more adverse events in the mupirocin group (p=0.025). Conclusions: This study provides evidence of efficacy and safety of povidone-iodine for preoperative nasal decontamination in cardiac surgery patients. Povidone-iodine may be considered as an alternative to mupirocin in the cardiac surgery population.

Randomized Placebo-Controlled Trial of Topical Mupirocin to Reduce Staphylococcus aureus Colonization in Infants in the Neonatal Intensive Care Unit

To evaluate the efficacy of topical mupirocin in reducing Staphylococcus aureus colonization in infants in the neonatal intensive care unit (NICU). A prospective double-blind randomized controlled trial of mupirocin vs placebo in S aureus-colonized infants was conducted in a tertiary care NICU between October 2016 and December 2019. Weekly universal active surveillance with polymerase chain reaction screening identified colonized infants. Colonized infants received a 5-day course of mupirocin (mupirocin group) or petroleum jelly (control group). Repeat courses were given for additional positive screens. A total of 216 infants were enrolled; 205 were included in data analyses. Primary decolonization was more successful for mupirocin-treated infants (86 of 104 [83%]) than for controls (20 of 101; 20%) (P<.001). Although recurrent S aureus colonization occurred frequently (59 of 81 [73%] mupirocin-treated and 26 of 33 [79%] controls), subsequent decolonization remained more successful for mupirocin-treated infants than for controls (38 of 49 [78%] vs 2 of 21 [10%]; P<.001). Subgroup analyses of infants of ≤30weeks' gestational age yielded similar results; decolonization occurred more often in mupirocin-treated infants compared with control infants (63 of 76 [83%] vs 13 of 74 [18%]; P<.001). Bacterial sterile site infections tended to be less frequent in mupirocin-treated infants compared with controls (2 of 104 [2%] vs 8 of 101 [8%]; P=.057). No invasive S aureus infections occurred in mupirocin-treated infants, but 50% of infections in controls were from S aureus, and 1 resulted in death. Universal active surveillance and targeted treatment with topical mupirocin is a successful decolonization strategy for NICU infants and may prevent S aureus infection. However, S aureus colonization frequently recurs, necessitating repeat treatment. Clinicaltrials.gov: NCT02967432.

Octenidine dihydrochloride treatment of a meticillin-resistant Staphylococcus aureus biofilm-infected mouse wound.

This study sought to estimate the effect of a liquid octenidine dihydrochloride (OCT)-impregnated gauze dressing in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) biofilm-infected wounds. In this animal study, a six-millimetre punch full-thickness wound on each mouse back was inoculated with MRSA suspension, and then covered with a Tegaderm (3M Health Care, US) dressing for an established biofilm model. Animals were divided into three groups for topical application: control group (treated with phosphate-buffered saline, PBS); mupirocin group (treated with 2% mupirocin); and OCT group (treated with OCT). All applications were administrated once 24 hours post-wounding. The bioburden was determined by counting colony-forming units (cfus) and the biofilm architecture was viewed using fluorescent staining and scanning electron microscopy (SEM) on day two. The tissue repair was evaluated histologically and the related genes were detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) on day 15. The results suggested OCT accelerated healing and reduced by >3.6 log cfu/g bacterial counts on the wounds relative to the PBS-treated control (p<0.05). Histological analysis showed OCT-treated tissue exhibited lower burden of the inflammatory cells, more mature collagen fibres and well-defined epithelialisation. LIVE/DEAD fluorescent staining and SEM confirmed OCT induced a substantial destruction to biofilm structure. RT-qPCR further demonstrated that OCT therapy could inhibit the expression of MRSA and its biofilm genes by nearly 100% (p<0.05). This investigation provides a rare in vivo experimental basis for OCT improvement on MRSA-infected wound healing and the superior efficacy implies OCT topical application may represent an ideal choice to address established bacterial biofilm in hard-to-heal wounds.

Efficacy of Carragelose® Nasal Spray Impregnated Versus Mupirocin Ointment Impregnated Nasal Packs on Mucosal Healing after Endoscopic Sinus Surgery: A Double-Blind, Non-Randomized, Right-Left Side Comparison

ABSTRACTObjective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS).&#x0D; Methods:Design: Double-Blind, Non-Randomized, Right-Left Side ComparisonSetting: Tertiary Government Training HospitalParticipants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system.&#x0D; Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151).&#x0D; Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.

Topical co-administration of Teucrium polium hydroethanolic extract and Aloe vera gel triggered wound healing by accelerating cell proliferation in diabetic mouse model

Diabetic wounds are major issues in patients with diabetes. Medicinal plants of Teucrium polium and Aloe vera have antioxidant and anti-inflammatory properties that may be profitable for diabetic patients. This study was conducted to evaluate the effect of co-administration of ointments prepared from Teucrium polium hydroethanolic extract (TPEO) and Aloe vera gel (AVGO) on excisional wound healing in a diabetic mouse model. Following the induction of diabetes and circular excisional wound (7 mm), the mice were divided into six groups, namely (Ⅰ) control mice treated with mupirocin (as a standard drug), (Ⅱ and Ⅲ) the mice treated with 5 and 10 % TPEO, (Ⅳ and Ⅴ) the mice treated with 5 and 10 % AVGO, and (Ⅵ) the mice treated with a combination of 5% TPEO and 5% AVGO (TPEO+AVGO). To investigate the wound area, we further evaluated the wound area ratio, histological analysis and the serum levels of tissue antioxidant capacity (TAC) and malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β), immunohistochemistry staining for vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF-1), glucose transporter-1(GLUT-1) and collagen type 1 and mRNA expression levels for VEGF, IGF-1, GLUT-1 and fibroblast growth factor-2 (FGF-2). The results showed that administration of the ointments, especially in combination form, shortened the inflammatory phase and reduced the levels of tissue MDA, TNF-α and IL-1β compared to mupirocin group (P < 0.05). Moreover, fibroblasts proliferation, collagen deposition, VEGF, IGF-1, GLUT-1-positive cells and level of TAC, and expressions of VEGF, IGF-1, GLUT-1 and FGF-2 were significantly (P < 0.05) increased in TPEO and AVGO, and especially in the mice treated with the mixed form. Therefore, topical co-administration of TPEO + AVGO accelerated open diabetic wound healing through shortening the inflammatory phase and increasing cell proliferation and collagen deposition.

An evaluation of safety and efficacy of nadifloxacin 1% ointment versus mupirocin 1% ointment in Indian children with skin and soft tissue infection

Background: Although nadifloxacin has been shown to be effective in the treatment of skin &amp; soft tissue infections (SSTI), there is a paucity of data comparing its efficacy and safety with other antibacterials, especially in Indian paediatric population. Therefore, objective of this study was to compare the safety and efficacy of nadifloxacin with mupirocin in children with SSTI.Methods: This was a single-centre, open label, randomized, parallel group, comparative study in 60 children of &lt;12 years of age with SSTI. Test group (n=30) received nadifloxacin 1% ointment and reference group (n=30) received mupirocin 1% ointment, to be applied twice daily. Patients were followed up at day 4, 8 and 15. Efficacy of the study drugs was evaluated by clinical and bacteriological cure rate. Safety was assessed by reporting of adverse events.Results: Baseline characteristics of enrolled patients were comparable between treatment groups and all 60 patients completed the study. At Day 15, 100.0% cases among nadifloxacin group and 96.7% cases among mupirocin group achieved clinical cure (p=0.313). The most common bacteria found in culture were Gram positive cocci in both the groups (86.7% in nadifloxacin and 58.8% in mupirocin group). None of the cases in any of the groups showed bacteriological presence at day 15. No adverse event was reported in any of the treatment groups during the study duration.Conclusions: Nadifloxacin was found to be equally efficacious and safe to mupirocin in the treatment of SSTI in Indian pediatric population.

Efficacy and cost effectiveness comparision between fusidic acid and mupirocin for impetigo

Introduction: Impetigo is a contagious skin infection due to S. aureus or S. pyogenes that usually affects children. BNF recommends topical fusidic acid or mupirocin for impetigo. This study compares the efficacy and cost-effectiveness of topical fusidic acid and mupirocin in treatment of impetigo. Materials and Methods: This was an open label, prospective study done on 100 impetigo patients attending OPD of Viswabharathi General & Teaching Hospital, Kurnool, Andhra Pradesh, India from January 2016 to December 2016. The primary end points were evaluated at the baseline, and after one week of treatment. The end points were: number of lesions, size of the lesions, SSI score and cost to treat a single case. Patients were randomly allocated to two groups – fusidic acid group and mupirocin group. In both groups the test drug was applied locally thrice daily. Statistical analysis was done using student’s paired t test and unpaired t test. p-value of Results: In fusidic acid group; number of lesions declined from 4.24±1.17 to 0.24±0.82, wound area (cm2) decreased from 3.24±0.95 to 0.34±1.18 and SSI decreased from 2.32±0.47 to 0.14±0.49. While in mupirocin group; number of lesions declined from 4.16±1.11 to 0.14±0.70, wound area (cm2) decreased from 3.45±1.14 to 0.17±0.85 and SSI decreased from 2.44±0.50 to 0.08±0.39. All these changes were statistically significant. Cost to treat one case was INR 46 for fusidic acid and INR 72 for mupirocin. Conclusion: Mupirocin is marginally more effective than fusidic acid but this difference was not statistically significant. Cost effectiveness of fusidic acid is less than mupirocin. Keywords: Fusidic acid, Mupirocin, Impetigo, Cost-effectiveness, Efficacy, Comparison.

Impact of mupirocin and betadine-impregnated urethral catheter on the incidence rate of catheter-related bacteriuria and urinary tract infections, in comparison with conventional catheterization

Introduction: One of the most common nosocomial infections is urinary tract infection (UTI), which more commonly seen in patients with urethral catheter. Inappropriate use of urinary catheter can lead to certain complications including infection. Objectives: The aim of this study was to evaluate the effect of using mupirocin and betadineimpregnated urethral catheters in comparison with conventional catheterization on the incidence rate of catheter-related bacteriuria (CRB) and UTIs. Patients and Methods: In this parallel randomized clinical trial, phase III, a total of 150 patients (male and female) ranging from 18-75 years who needed urinary catheterization were randomly assigned into three evenly distributed groups; betadine, mupirocin, and conventional (control) through permuted block randomization. Sterile urine samples were examined for bacteriuria after catheter insertion and at the time of catheter removal. Results: The mean age of the patients was 49.81 (±15.11) years. UTI was seen most frequently in the conventional group (56%), and least frequently in the mupirocin group (24%) (P&lt;0.004). A significant difference was observed in incidence of post-catheterization UTI between the conventional and mupirocin groups, as well as between the conventional and betadine groups (P=0.001 and P=0.04, respectively). Conclusion: Using antibiotic and antiseptic-impregnated catheters (both mupirocin and betadine) could help to decrease the incidence rate of UTI in comparison to the conventional catheterization. Trial registration: The trial was registered with the TCTR ID: TCTR20200627001 (http:// www.clinicaltrials.in.th/index.php?tp=regtrials&amp;menu=trialsearch&amp;smenu=fulltext&amp;task=s earch&amp;task2=view1&amp;id=6442).

A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial

IntroductionNipple fissure and nipple pain are common complaints among breastfeeding mothers. Studies found that mupirocin was effective in preventing and treating infections of damaged nipple and nipple pain. Acidic fibroblast...

Comparison of efficacy and cost-effectiveness of topical fusidic acid and topical mupirocin in the treatment of impetigo

Background: Impetigo is a highly contagious skin infection of the superficial epidermis that most often affects the age group of 2–5 years children, although it can occur in any age group. Topical antibiotics as the advantage of being applied only where needed, minimizing antibiotic resistance and avoiding gastrointestinal and other systemic adverse effects. Aims and Objectives: This study aimed to evaluate the efficacy and cost-effectiveness of topical fusidic acid and mupirocin in the treatment of Impetigo. Materials and Methods: This was an open-label, prospective study conducted on 100 patients of impetigo. The present study was conducted at the Department of Pharmacology in collaboration with the Department of Dermatology of Osmania General Hospital, Hyderabad, India, from August 2016 to July 2017. Patients were randomly allocated to two groups, namely Group I receiving topical fusidic acid 2% and Group II receiving topical mupirocin 2% thrice daily for 1 week. At the end of the 1st week, a detailed clinical examination was performed. Scoring System of Impetigo (SSI), number of lesions, and size of existing lesions were measured. The clinical outcome was graded as mild-to-moderate (SSI score 1 or 2 and presence of lesions) and good (SSI score 0 and no lesions). Results: Statistical analysis was performed using the Student’s paired t-test and unpaired t-test. P < 0.05 was considered statistically significant. In the fusidic acid group, the number of lesions (mean ± SD) declined from 4.24 ± 1.17 to 0.24 ± 0.82, wound area decreased from 3.24 ± 0.95 to 0.34 ± 1.18, and SSI decreased from 2.32 ± 0.47 to 0.14 ± 0.49. While in the mupirocin group, the number of lesions declined from 4.16 ± 1.11 to 0.14 ± 0.70, wound area decreased from 3.45 ± 1.14 to 0.17 ± 0.85, and SSI decreased from 2.44 ± 0.50 to 0.08 ± 0.39. All these parameters were statistically significant. Adverse events in both groups were mild and did not require any specific treatments. Cost incurred to treat one case successfully was 46 Indian National Rupee (INR) for fusidic acid and 72 INR for mupirocin. Conclusion: In this study, at the end of the 1st week, efficacy is 92% in Group I receiving topical fusidic acid 2% and 96% in Group II receiving topical mupirocin 2%. There is no statistically significant difference between the two groups (P > 0.05) as calculated by the unpaired t-test. The cost incurred to treat one case successfully is less with fusidic acid (INR 46) as compared to mupirocin (INR 72) (cost-effectiveness). Hence, fusidic acid is more cost-effective than mupirocin.

The effect of mupirocin dressings on postoperative surgical site infections in elective colorectal surgery: A prospective, randomized controlled trial

BackgroundSurgical site infections (SSIs) are the most common nosocomial infection among surgical patients. We hypothesized that mupirocin ointment would decrease SSI rates compared to standard surgical dressings in patients undergoing colorectal surgery. MethodsA prospective randomized controlled trial was performed, including patients undergoing elective open and minimally invasive colorectal surgery. Patients were randomized 1:1 to receive standard gauze dressings or mupirocin ointment (2%) dressings. The primary outcome was incisional SSI at 30 days postoperative. ResultsA total of 192 patients were enrolled; 150 underwent randomization: 75 to the mupirocin arm, and 75 to the standard gauze dressing arm. Three SSIs occurred; one (1%) in the mupirocin group, and two (3%) in the standard gauze group (P = 0.560). There was no significant difference between standard gauze dressings and mupirocin dressings. ConclusionMupirocin (2%) ointment failed to show a benefit compared to standard dressings for postoperative SSI.

Efficacy of topical 2% mupirocin ointment for treatment of tympanostomy tube otorrhea caused by community-acquired methicillin resistant Staphylococcus aureus

ObjectiveTo demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA). MethodsWe treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/− ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared. Results29 children (37 ears) with MRSA TTO were included. 8 children (12 ears) received adjunctive topical mupirocin ointment – 21 children (25 ears) did not. 8 of 12 ears in the mupirocin group received concomitant systemic antibiotics – 4 ears were treated with topical mupirocin alone. The mean duration of follow-up of the mupirocin group was 7 months (with 95% C.I of 7 ± 7). The control group was 24 months (with 95% C.I of 24 ± 9). Recurrence of MRSA TTO in the mupirocin and control groups were 0/12; 0% and 10/25; 40%, by ear, respectively (p = 0.015). Recurrence of non-MRSA TTO in the mupirocin and control groups were 6/12; 50% and 9/25; 36%, by ear, respectively (p = 1.0). There were no sensorineural hearing losses in the mupirocin-treated children. ConclusionIn this small series, a single application of topical mupirocin in combination with mechanical debridement, controlled infection by CA-MRSA without evidence of local reaction or subsequent hearing loss. Its role in treatment of MRSA TTO merits further investigation.

Infections after photodynamic therapy in Condyloma acuminatum patients: incidence and management.

Condyloma acuminatum (CA), or genital wart, is a sexually transmitted infection caused by human papillomaviruses. Increasing evidences demonstrated that photodynamic therapy (PDT) is effective in eliminating latent HPV infection, the major reason for CA recurrence. We observed an increasing number of infections after PDT in CA patients, which has not been reported before. This study aims to evaluate the incidence and management of infection in CA patients after PDT procedure. CA patients received PDT from January 2015 to February 2016 at the outpatient setting. Patients were randomly divided into two groups: the control group and fusidic acid group. Patients in the fusidic acid group used topical fusidic acid (2%) and recombinant human interferon after 5-aminolevulinic acid (ALA)-PDT procedure, while patients in the control group only used recombinant human interferon. Patients came to our department for follow-up evaluations at 4, 8, and 12weeks after treatment for three times of PDT. Patients with ALA-PDT-associated infection were then randomly divided into two groups: the fusidic acid group and mupirocin group. During the 13-month study period, a total of 718 patients with 2154 times of PDT procedures were enrolled. The infection rate after PDT was 8.5% in the control group, while it was 1.1% in the prophylactic topical fusidic acid group. The cure rate of PDT-associated infection was 85.7% in the fusidic acid group and 86.7% in the mupirocin group. In conclusion, prophylactic topical antibiotic was useful for reduction of PDT-associated infection and optimal wound healing in CA patients.

Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers.

Surgical site infection rates in the month following surgery vary from 1% to 5%. Due to the large number of surgical procedures conducted annually, the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Nasal decontamination using antibiotics or antiseptics is performed to reduce the risk of SSIs by preventing organisms from the nasal cavity being transferred to the skin where a surgical incision will be made. Staphylococcus aureus (S aureus) colonises the nasal cavity and skin of carriers and can cause infection in open or unhealed surgical wounds. S aureus is the leading nosocomial (hospital-acquired) pathogen in hospitals worldwide. The potential effectiveness of nasal decontamination of S aureus is thought to be dependent on both the antibiotic/antiseptic used and the dose of application; however, it is unclear whether nasal decontamination actually reduces postoperative wound infection in S aureus carriers. To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing surgery. In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus. We also searched three clinical trial registries and the references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting. Randomised controlled trials (RCTs) which enrolled S aureus carriers with any type of surgery and assessed the use of nasal decontamination with antiseptic/antibiotic properties were included in the review. Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment. We located two studies (291 participants) for inclusion in this review. The trials were clinically heterogeneous with differences in duration of follow-up, and nasal decontamination regimens. One study compared mupirocin (2% contained in a base of polyethylene glycol 400 and polyethylene glycol 3350) with a placebo in elective cardiac surgery patients; and one study compared Anerdian (iodine 0.45% to 0.57% (W/V), chlorhexidine acetate 0.09% to 0.11% (W/V)) with no treatment also in cardiac surgery patients. The trials reported limited outcome data on SSI, adverse events and secondary outcomes (e.g. S aureus SSI, mortality). Mupirocin compared with placeboThis study found no clear difference in SSI risk following use of mupirocin compared with placebo (1 trial, 257 participants); risk ratio (RR) 1.60, 95% confidence interval (CI) 0.79 to 3.25 based on 18/130 events in the mupirocin group and 11/127 in the control group; low-certainty evidence (downgraded twice due to imprecision). Anerdian compared with no treatmentIt is uncertain whether there is a difference in SSI risk following treatment with Anerdian compared with no treatment (1 trial, 34 participants); RR 0.89, 95% CI 0.06 to 13.08 based on 1/18 events in the Anerdian group and 1/16 in the control group; very low certainty evidence (downgraded twice due to imprecision and once due to risk of bias). There is currently limited rigorous RCT evidence available regarding the clinical effectiveness of nasal decontamination in the prevention of SSI. This limitation is specific to the focused question our review addresses, looking at nasal decontamination as a single intervention in participants undergoing surgery who are known S aureus carriers. We were only able to identify two studies that met the inclusion criteria for this review and one of these was very small and poorly reported. The potential benefits and harms of using decontamination for the prevention of SSI in this group of people remain uncertain.

Comparison of topical mupirocin and gentamicin in the prevention of peritoneal dialysis-related infections: A systematic review and meta-analysis

BackgroundTopical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin. MethodsMultiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis. ResultsSeven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate. ConclusionsTopical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection.

Effect of 2% Nasal Mupirocin Ointment on Decreasing Complications of Nasotracheal Intubation: A Randomized Controlled Trial.

In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon's access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea. To evaluate the effect of 2% nasal mupirocin ointment before and after nasotracheal intubation on decreasing the complications of intubation for oral and maxillofacial surgeries. In the present single blinded randomised controlled clinical trial, 44 patients were randomly assigned to two equal groups. A sterile swab was used, eight to 10 hours before nasotracheal intubation, to take a sample for culturing from the vestibule of nostrils and the anterior septum of the patients. In Group 1, 2% nasal mupirocin ointment was applied to the vestibules of both nostrils and the anterior septum. In Group 2, no intervention was carried out. After general anaesthesia and extubation, microbial cultures were prepared from the 4 cm distal end of the tube and antibiogram test was carried out. Also, the patients were compared in terms of the severity of nasal bleeding, the ease of breathing through the nose after nasotracheal intubation. Data were analysed with suitable statistical tests. In the mupirocin group, 27.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but no S. aureus was detected at the distal end of nasotracheal tube after extubation. In the control group, 18.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but there was no change in the number of S. aureus counts at the distal end of nasotracheal tube (p-value<0.001). After extubation, in the mupirocin and control groups, 18.2% and 22.7% of the subjects, respectively, exhibited severe bleeding (p-value=0.001). In the mupirocin and control groups, 86.4% and 59.1% of the subjects had easy extubation, respectively (p-value=0.044). In the mupirocin and control groups, 9.1% and 63.7% of the subjects immediately after regaining consciousness and 9.1% and 54.6% three hours after extubation had difficulty in breathing, respectively (p-value=0.001). Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of S. aureus and other gram-negative bacteria.

Prophylactic treatment of chronic renal disease in patients undergoing peritoneal dialysis and colonized by Staphylococcus aureus: a systematic review and meta-analysis.

BackgroundThis study was performed to evaluate the clinical effectiveness of alternative strategies for the prevention and treatment of patients with chronic kidney disease undergoing peritoneal dialysis and colonized by Staphylococcus aureus.MethodsA systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were “Staphylococcus aureus,” “MRSA,” “MSSA,” “treatment,” “decolonization,” “nasal carrier,” “colonization,” “chronic kidney disease,” “dialysis,” and “peritoneal dialysis.” Randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various antibiotic treatments (antibiotic group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). Patients in the antibiotic group were also compared with those in the mupirocin group.ResultsIn total, nine studies involving 839 patients were included in the analysis, 187 (22.3 %) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for peritoneal dialysis was 74 % lower in the mupirocin than control group (odds ratio [OR], 0.26; 95 % confidence interval [CI], 0.14–0.46; p < 0.001), 56 % lower in the antibiotic than control group (OR, 0.44; 95 % CI, 0.19–0.99; p = 0.048), and 52 % lower in the mupirocin than antibiotic group (OR, 0.48; 95 % CI, 0.21–1.10; p = 0.084). The difference in the probability of S. aureus peritonitis in patients undergoing peritoneal dialysis was not statistically significant among the three groups.ConclusionsMupirocin and topical antibiotics were effective for reduction of S. aureus catheter site infection in patients undergoing peritoneal dialysis when compared with no treatment or placebo. However, evidence was insufficient to identify the optimal agent, route, or duration of antibiotics to treat peritonitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0329-0) contains supplementary material, which is available to authorized users.

Chlorhexidine for routine PD catheter exit-site care.

Although guidelines suggest the routine use of mupirocin or gentamicin at the exit site of PD catheter, our PD unit has been using chlorhexidine gluconate 0.5% as exit-site care protocol. The aim of this study was to ascertain whether mupirocin application is superior to the traditionally applied chlorhexidine-regarding prevention of exit-site infections and peritonitis in our unit. Stable incident and prevalent patients of our unit were randomized to apply mupirocin or chlorhexidine at exit site. The study started on July 1, 2010, and continued till December 2014. End point was the first episode of exit-site infection or peritonitis. Sixty-two patients (mean age 58.5±14.6years) were randomized. At the end of follow-up, there were 33 patients on mupirocin treatment and 29 on chlorhexidine. The two groups had no differences in age, sex, PD vintage or PD mode. The only difference between the two groups was the percentage of patients with diabetes, 28% in chlorhexidine group versus 10% in mupirocin group. Mean time of follow-up was 28.46±16.37months. Twenty-four episodes of infections (peritonitis and exit site) were recorded. Time to first infection episode was 32months in mupirocin group (95% CI 21.4-42.5) versus 29months (95% CI 8.6-49.4) in chlorhexidine group. The Kaplan-Meier survival analysis revealed no difference in the infections between the two protocols (log-rank test, p=0.477). Mupirocin is not superior in preventing infections comparing with chlorhexidine in this cohort of patients.

The effect of mupirocin- and fusidic acid-nasal packings, placed after septoplasty, on the nasal bacterial profile.

Aim:To examine the effects, after septoplasty, of local antibiotic pomades as an alternative to prophylactic antibiotic use, which is a controversial matter among the otolaryngologists, on nasal flora and bacterial growth.Material and Method:Nasal packings placed after septoplasty surgery to provide septal stabilization and bleeding control pose a risk in terms of infection. In this study, 106 patients, who were examined by comparing mupirocin- and fusidic acid–soaked packings and antibiotic-free packings, were divided into three groups. Nasal cultures were obtained from each patient twice, before the surgery and on the second day immediately after the packings were removed, and the culture results were statistically compared.Results:In the mupirocin group (group 2), postoperative normal flora growth rate was significantly higher than in the fusidic acid group (group 3) and the antibiotic-free group (group 1) (p < 0.024). In the mupirocin group (group 2), the gram-positive growth rate in the postoperative period showed a significant decrease when compared when the preoperative period (p < 0.05) (5.7%). In the fusidic acid group (group 3), the postoperative gram-positive rate showed a significant decrease compared with the preoperative period (p < 0.05). In group 2, the postoperative methicillin-resistant Staphylococcus aureus rate showed a significant decrease than in the preoperative period (2.9%) (p < 0.05). Similarly, in group 3, the postoperative methicillin-resistant S. aureus rate showed a significant decrease compared with that of the preoperative period (11.1%) (p < 0.05).Conclusion:Use of mupirocin- and fusidic acid–soaked nasal packings after septoplasty significantly decreased, especially, postoperative gram-positive bacterial growth in nasal cultures. Although systemic antibiotherapy was not administered, the lack of local and systemic infection findings was an important result that we obtained in terms of clinical use. Usage advantages of mupirocin and fusidic acid soaked packings are an easily applicable, cost-effective, and safe method.

Screening and treatment for Staphylococcus aureus in patients undergoing hemodialysis: a systematic review and meta-analysis.

BackgroundThis study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.MethodsA systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were “Staphylococcus aureus”, “MRSA”, “MSSA”, “treatment”, “decolonization”, “nasal carrier”, “colonization”, “chronic kidney disease”, “dialysis”, and “haemodialysis” or “hemodialysis”. Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.ResultsIn total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05–0.34; p < 0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08–0.42; p < 0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51–1.15; p = 0.20).ConclusionsTwenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-202) contains supplementary material, which is available to authorized users.