mupirocin and Postoperative-Complications

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

Topics: Administration, Intranasal; Antibiotic Prophylaxis; Carrier State; Humans; Mupirocin; Postoperative Complications; Randomized Controlled Trials as Topic; Staphylococcal Infections; Staphylococcus aureus

Postoperative nosocomial infections are associated with increased cost, hospitalization, and morbidity. S. aureus is the most common organism that contributes to postoperative nosocomial infections, and causes up to 25% of these infections. The role of the nose as a reservoir for S. aureus and possible subsequent endogenous infections has been recognized for approximately 40 years. Elimination of nasal carriage of S. aureus may be another intervention aimed at reducing postoperative infections. Mupirocin, a topical antibiotic effective against Gram-positive organisms, was proved to be effective in reducing the rates of nasal colonization of S. aureus and decreased postoperative nosocomial infections due to S. aureus.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Female; Follow-Up Studies; Humans; Male; Mupirocin; Nasal Mucosa; Postoperative Complications; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Nasal lavage with mupirocin has the potential to reduce sinonasal morbidity in endoscopic endonasal approaches for skull base surgery.. To evaluate the effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery.. A pilot randomised, controlled trial was conducted on 20 adult patients who had undergone endoscopic endonasal approaches for skull base lesions. These patients were randomly assigned to cohorts using nasal lavages with mupirocin or without mupirocin. Patients were assessed in the out-patient clinic, one week and one month after surgery, using the 22-item Sino-Nasal Outcome Test questionnaire and nasal endoscopy.. Patients in the mupirocin nasal lavage group had lower nasal endoscopy scores post-operatively, and a statistically significant larger difference in nasal endoscopy scores at one month compared to one week. The mupirocin nasal lavage group also showed better Sino-Nasal Outcome Test scores at one month compared to the group without mupirocin.. Nasal lavage with mupirocin seems to yield better outcomes regarding patients' symptoms and endoscopic findings.

Topics: Adult; Aged; Antibiotic Prophylaxis; Endoscopy; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Lavage; Nasal Surgical Procedures; Pilot Projects; Postoperative Complications; Skull Base; Skull Base Neoplasms; Treatment Outcome; Young Adult

A blinded randomized clinical trial was undertaken to evaluate the effect of applying ointment to a wound before occlusive dressing, in comparison with no ointment or sterile paraffin.. Some 778 patients with 1801 surgical wounds following excision of skin lesions were enrolled in the trial. No ointment was placed on 510 sutured wounds of 247 patients, paraffin ointment was put on 729 wounds (269 patients) and mupirocin ointment on 562 wounds (262 patients). Wound infection, scar, haemorrhage, dehiscence and other complications were assessed at suture removal. At 6-9 months after surgery, patients were surveyed to assess the wounds, with a response rate of 74.0 per cent.. There were no significant differences in outcome for all endpoints evaluated. The infection rate was 1.4 per cent with no ointment, 1.6 per cent for paraffin and 2.3 per cent for mupirocin (P = 0.490). Total complication rates were 3.5, 4.7 and 4.8 per cent for no ointment, paraffin and mupirocin respectively (P = 0.590). Some 10.9, 10.3 and 8.2 per cent of patients respectively had a neutral or negative perception of their wounds at 6-9 months after surgery (P = 0.650). There was no difference in postoperative pain, degree of inconvenience or overall level of satisfaction with treatment.. Putting ointment on a surgical wound before occlusive dressing does not benefit the patient. In view of the risk of antibiotic resistance, mupirocin ointment is not indicated for clean surgical wounds.

Topics: Adult; Aged; Anti-Bacterial Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Occlusive Dressings; Ointments; Postoperative Complications; Prospective Studies; Treatment Outcome; Wound Healing

The objective of this study was to determine whether use of mupirocin nasal ointment for perioperative eradication of Staphylococcus aureus nasal carriage is effective in preventing the development of surgical site infections (SSIs). A randomized, double-blind, placebo-controlled design was used. Either mupirocin or placebo nasal ointment was applied twice daily to 614 assessable patients from the day of admission to the hospital until the day of surgery. A total of 315 and 299 patients were randomized to receive mupirocin and placebo, respectively. Eradication of nasal carriage was significantly more effective in the mupirocin group (eradication rate, 83.5% versus 27.8%). In the mupirocin group, the rate of endogenous S. aureus infections was 5 times lower than in the placebo group (0.3% and 1.7%, respectively; relative risk, 0.19; 95% confidence interval, 0.02-1.62). Mupirocin nasal ointment did not reduce the SSI rate (by S. aureus) or the duration of hospital stay.

Topics: Anti-Bacterial Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Ointments; Orthopedics; Perioperative Care; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus

Surgical site infections after cardiac surgery are associated with severe outcomes, including reoperation and death. We aimed to describe the effect of a standardized clinical-care protocol for preventing mediastinitis in patients who underwent coronary artery bypass graft surgery (CABG).. In a hospital certified by Joint Commission International, all patients who underwent CABG from January 2011 to December 2016 were compared in two periods according to the moment of implementation of a standardized clinical-care protocol for prevention of mediastinitis (CCPPM): pre-protocol (January 2011-December 2012) and post-protocol (January 2013-December 2016). The CCPPM consisted of the patient using a kit containing chlorhexidine 2% for bathing, mupirocin 20 mg/g for nasal topical use and chlorhexidine 0.12% for oral hygiene for 5 days before surgery, in addition to prophylaxis with a glycopeptide antimicrobial and strict glucose control (110-140 mg/dL) during surgery and immediate postoperative.. We evaluated 1760 patients who underwent CABG in both periods. The occurrence of mediastinitis before protocol implementation was 1.44% (10 of 692 CABG). After the implementation of the protocol, there was an important reduction in the incidence of mediastinitis to 0.09% (1 of 1068 CABG) (P = 0.002). Although we did not observe a significant difference in mortality between the groups (2.3% vs 1%, P = 0.77), there was fewer in-hospital mortality due to mediastinitis after the CCPPM (0.2% vs 0%, P < 0.001).. Implementation of a standardized CCPPM was associated with a significant reduction in the incidence of mediastinitis after CABG and reduction of mortality in the group of patients with mediastinitis.

Topics: Administration, Topical; Aged; Antibiotic Prophylaxis; Baths; Chlorhexidine; Coronary Artery Bypass; Female; Hospital Mortality; Hospitals, Private; Humans; Incidence; Male; Mediastinitis; Middle Aged; Mupirocin; Oral Hygiene; Patient Care; Postoperative Complications; Quality of Health Care; Time Factors

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Chlorhexidine; Drug Resistance, Bacterial; Female; Hexachlorophene; Humans; Male; Medication Adherence; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Mupirocin; Nose; Postoperative Complications; Staphylococcal Infections; Surveys and Questionnaires

To examine the efficacy of preoperative Staphylococcus aureus screening on postoperative methicillin-resistant S aureus (MRSA) infection rates in otolaryngology.. Chart review.. Postoperative MRSA infection rates in unscreened patients during a 1-year period were compared with infection rates in patients after preoperative S aureus screening was initiated. Colonized patients were treated with mupirocin and chlorhexidine preoperatively.. Records of 420 patients were reviewed. In the 241 patients without screening, nine patients had S aureus infections, and there were two (0.8%) postoperative MRSA surgical-site infections. Of 179 patients after screening was initiated, 24 patients (13.4%) were colonized with S aureus and underwent preoperative treatment. There were no MRSA infections in the postoperative period.. Early results show the potential benefit of preoperative S aureus screening in MRSA infection rate reduction. Although larger studies are needed, screening and treatment of MRSA colonized patients preoperatively may reduce infectious complications in otolaryngology.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Preoperative Care; Staphylococcal Infections

We report a patient who underwent implantation of a DeBakey left-ventricular assist device and developed a methicillin-resistant Staphylococcus aureus drive line infection on postoperative day 304. The patient was forwarded to urgent heart transplantation with a successful outcome.

Topics: Adolescent; Azathioprine; Cardiomyopathy, Dilated; Cyclosporine; Equipment Contamination; Heart Transplantation; Heart-Assist Devices; Humans; Immunosuppressive Agents; Male; Methicillin Resistance; Methylprednisolone; Mupirocin; Patient Isolation; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Nasal carriage of Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) is associated with an increased risk for postoperative staphylococcal infection. This study was conducted to investigate the effect of preoperative nasal mupirocin treatment on the postoperative infections in patients undergoing upper gastrointestinal surgery. The intervention group consisted of 141 consecutive patients who underwent upper gastrointestinal surgery between March 1, 1997, and February 28, 1998. The patients in the intervention group were treated with intranasal mupirocin three times a day for 3 consecutive days before surgery. The incidence of postoperative staphylococcal infections in the intervention group was then compared with that of the historical control group. The control group consisted of 128 consecutive patients who underwent upper gastrointestinal surgery without mupirocin treatment between January 1, 1996 and December 31, 1996. The postoperative staphylococcal infection rate in the control group (11.7%) was significantly higher (P < 0.001) than in the intervention group (0.71%). The postoperative MRSA infection rate was significantly reduced by the intervention (control group 7.0% and intervention group 0%; P < 0.01). These results suggest that preoperative nasal eradication of S. aureus with mupirocin thus appears to be an effective measure to prevent postoperative staphylococcal infection in patients undergoing upper gastrointestinal surgery.

Topics: Administration, Intranasal; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Digestive System Surgical Procedures; Female; Humans; Incidence; Male; Methicillin Resistance; Middle Aged; Mupirocin; Ointments; Postoperative Complications; Staphylococcal Infections