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Use of intranasal mupirocin to prevent methicillin-resistant Staphylococcus aureus infection in intensive care units

Arno Muller1, Daniel Talon2, Alexandre Potier3, Evelyne Belle4, Gilles Cappelier5 and Xavier Bertrand6*

Author Affiliations

1 Student, Service d'Hygiène hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France

2 Head of Department, Service d'Hygiène hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France

3 House Officer, Service de Réanimation médicale Centre Hospitalier Universitaire Jean Minjoz, Besançon, France

4 Clinician, Service de Réanimation médicale Centre Hospitalier Universitaire Jean Minjoz, Besançon, France

5 Head of Department, Service de Réanimation médicale Centre Hospitalier Universitaire Jean Minjoz, Besançon, France

6 Clincian, Service d'Hygiène hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France

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Critical Care 2005, 9:R246-R250 doi:10.1186/cc3512


See related commentary http://ccforum.com/content/9/3/257

Published: 31 March 2005

Abstract

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) causes severe morbidity and mortality in intensive care units (ICUs) worldwide. The purpose of this study was to determine whether intranasal mupirocin prophylaxis is useful to prevent ICU-acquired infections with MRSA.

Materials and methods

We conducted a 4-year observational retrospective study in a 15-bed adult medical ICU. During the first 2-year period mupirocin ointment was included in the MRSA control programme; during the second, mupirocin was not used. The main endpoint was the number of endogenous ICU-acquired infections with MRSA.

Results

The number of endogenous acquired infections was significantly higher during the second period than during the first (11 versus 1; P = 0.02), although there was no significant difference in the total number of patients infected with MRSA between the two periods. We also observed that nasal MRSA decolonisation was significantly higher in the mupirocin period than in mupirocin-free period (P = 0.002).

Conclusion

Our findings suggest that intranasal mupirocin can prevent endogenous acquired MRSA infection in an ICU. Further double-blind, randomised, placebo-controlled studies are needed to demonstrate its cost-effectiveness and its impact on resistance.