Staphylococcal Infections Clinical Trial
Official title:
Investigation of the Influence of Intranasal Mupirocin on the Prevalence of S. Aureus Nosocomial Infections by Eradication of Intranasal S. Aureus
In order to evaluate the effect of eliminating nasal carriage by mupirocin prophylaxis on subsequent Staphylococcus aureus infection, a prospective randomized trial was performed particularly including patients with predisposing risk factors for S. aureus infections.
In a past study, we showed that there is a strong correlation between strains colonizing the
anterior nares, strains isolated from the presumed foci of infection, and strains isolated
from blood in patients with Staphylococcus aureus bacteremia. These results suggested that a
substantial proportion of cases of systemic S. aureus infections appear to be of endogenous
origin and that eradication of nasal colonization should be the chief strategy for reducing
the incidence of hospital-acquired S. aureus infections.
In order to evaluate the effect of eliminating nasal carriage by mupirocin prophylaxis on
subsequent S. aureus infection, a prospective randomized trial was performed particularly
including patients with predisposing risk factors for S. aureus infections. All patients
admitted to selected units in clinics for anaesthesiology, hemato-oncology, cardiac surgery,
and orthopedics at the University Hospital of Muenster were regularly screened for nasal
carriage, i.e. at admission and, subsequently, on a weekly basis. S. aureus carrying
patients were prospectively randomized, to be either treated with mupirocin for 5 days, or
left untreated. Patients infected with S. aureus at admission and patients detected to be
MRSA carrier were excluded from randomization.
Patients were regularly seen during the course of their hospital stay and
predisposing/conditional risk factors were systematically documented. In both groups
(untreated patients and patients with mupirocin prophylaxis), all nosocomial infections were
documented according to CDC guidelines. If infected, specimens were taken for
microbiological diagnosis. All S. aureus isolates (from the anterior nares as well as from
the focus of infection) were collected and were genotyped.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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