mupirocin and Skin-Neoplasms

Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus).. The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus.. The authors performed a randomized controlled trial of S. aureus nasal swab-negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention.. In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29).. Topical decolonization reduces SSI in nasal swab-negative Mohs surgery patients.

Topics: Administration, Intranasal; Administration, Topical; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Carrier State; Chlorhexidine; Decontamination; Female; Humans; Male; Middle Aged; Mohs Surgery; Mupirocin; Nose; Preoperative Care; Skin Neoplasms; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

The optimal method of reducing the risk of surgical site infection (SSI) after dermatologic surgery is unclear. Empiric, preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI. Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers. We compared the rates of infection in patients undergoing Mohs micrographic surgery (MMS) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization.. A randomized, controlled trial with 693 patients was conducted over a 30-week period at a single surgical practice. Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab. Nasal carriers of S. aureus were randomized to receive topical decolonization with intranasal mupirocin twice daily plus 4% chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre- and postoperative doses of oral cephalexin.. One hundred seventy-nine patients (25.8%) were identified as carriers of S. aureus. Ninety received topical decolonization, and 89 received oral antibiotics. These groups were compared with a swab-negative Mohs surgical cohort over the same time period. There were no significant differences between the groups in terms of demographic characteristics or comorbidities. Nine percent of patients receiving oral antibiotic prophylaxis and 0% receiving topical decolonization developed early SSI (p = .003).. In patients with demonstrable carriage of S. aureus, topical decolonization resulted in fewer SSI than in patients receiving perioperative oral antibiotics. Antibiotics should be reserved for clinically suspected and swab-proven infections rather than being prescribed empirically. Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS.

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Baths; Carrier State; Cephalexin; Chlorhexidine; Female; Humans; Male; Middle Aged; Mohs Surgery; Mupirocin; Nose; Skin Neoplasms; Staphylococcus aureus; Surgical Wound Infection

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Carcinoma, Basal Cell; Cephalexin; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Drug Combinations; Female; Humans; Male; Middle Aged; Mupirocin; Premedication; Skin Neoplasms; Staphylococcal Infections; Surgical Wound Dehiscence; Surgical Wound Infection

Topics: Administration, Cutaneous; Adult; Anti-Bacterial Agents; Dermatitis, Allergic Contact; Female; Histiocytoma; Humans; Multiple Chemical Sensitivity; Mupirocin; Patch Tests; Skin Neoplasms; Thigh

Topics: Biopsy, Needle; Buttocks; Child, Preschool; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunohistochemistry; Ketotifen; Male; Mastocytosis, Cutaneous; Mupirocin; Nevus, Pigmented; Prednisolone; Rare Diseases; Risk Assessment; Severity of Illness Index; Skin Neoplasms; Treatment Outcome

Topics: Administration, Oral; Administration, Topical; Chlorhexidine; Doxycycline; Drug Therapy, Combination; Female; Humans; Middle Aged; Mupirocin; Nevus, Pigmented; Sacrococcygeal Region; Skin Neoplasms; Superinfection

Mycosis fungoides (MF) and Sézary syndrome (SS), variants of cutaneous T-cell lymphoma, may arise from antigen-driven clonal expansion and accumulation of helper-memory T cells. Superantigens from Staphylococcus aureus can stimulate T cells.. (i) To determine the prevalence of S. aureus carriage in nares and skin in patients with MF/SS compared with historical rates in other conditions. (ii) To determine whether eradication of S. aureus carriage is associated with clinical improvement. Methods Skin and nares cultures were performed prospectively. Patients with positive nares and skin cultures were treated with oral antibiotics and intranasal mupirocin 2% and samples were taken for reculturing at 3 days, 4 weeks and 8 weeks. An exact binomial test was used to compare the carriage rates among different groups.. Among 106 patients with MF/SS, 67 (63%) had skin colonization and 57 (54%) had nasal colonization. Staphylococcus aureus was isolated from 44 patients, 33 (31%) each from skin and nares. Colonization was highest in erythrodermic SS (48%), similar to atopic dermatitis (64%), and lowest in MF without erythroderma (26%), psoriasis (21%), and the general population (10%). Oral and topical antibiotics eradicated S. aureus colonization in nares in 28 of 33 (85%) patients and in MF skin lesions in 30 of 33 (91%) patients at 4-8 weeks, with rapid clinical improvement seen in 58% of S. aureus-colonized patients.. Staphylococcal carriage in nares and skin lesions of patients with MF is similar to that in atopic dermatitis. Eradication of staphylococci from the skin is possible with treatment and was associated with clinical improvement.

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Mupirocin; Mycosis Fungoides; Nasal Cavity; Severity of Illness Index; Skin Neoplasms; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome

Presumed skin cancers were excised from 46 consecutive outpatients without antibiotic cover. A purulent wound developed in ten patients. Similar, but contaminated lesions were excised from 40 patients, but mupirocin ointment was used before surgery. Not one purulent wound developed out of 45 excisions.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Fatty Acids; Female; Humans; Male; Middle Aged; Mupirocin; Premedication; Skin Neoplasms; Surgical Wound Infection

A 36-year-old female patient with severe autosomal recessive dystrophic epidermolysis bullosa, who had spent her entire life from age 2 as an inpatient in the dermatology unit, recently died of metastatic squamous cell carcinoma of the skin. The development of malignancy was not prevented by continuous medical and nursing supervision and, despite early detection, rapidly led to her death. Oral phenytoin and topical mupirocin ointment had not reduced blistering.

Topics: Adult; Anti-Bacterial Agents; Carcinoma, Squamous Cell; Epidermolysis Bullosa; Fatty Acids; Female; Hand; Humans; Inpatients; Lung Neoplasms; Lymphatic Metastasis; Mupirocin; Phenytoin; Pleural Neoplasms; Skin Neoplasms