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Use of mupirocin to prevent methicillin resistant Staphylococcus aureus orthopedic surgical site infections

, : Use of mupirocin to prevent methicillin resistant Staphylococcus aureus orthopedic surgical site infections. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 41: 417

Backgound: Approximately two-thirds of Staphylococcus aureus SSIs are caused by MRSA, a problem exacerbated by the increased prevalence of nasal MRSA carriage in endemic settings. Systemic antimicrobial prophylaxis against MRSA has significant drawbacks. Methods: We examined use of perioperative prophylaxis with nasal mupirocin (PPNM) to prevent MRSA orthopedic SSIs, in a before and after study of 4 orthopedic wards where routine MRSA screening was not performed. Patients undergoing surgery involving insertion of metal prostheses and/or fixation were required to receive 5 days PPNM (day -1 to day +4) plus a shower or bath with 2%v/v triclosan before surgery. MRSA SSIs, defined using standardised (ASA/NNIS) criteria, in the 6 months before PPNM (period A) were compared with those in the next 6 month periods (B and C). Point prevalence nasal SA carriage was assessed before and regularly after PPNM began. SA isolates recovered from specimens or screenings were tested for mupirocin susceptibility. Results: MRSA SSIs (per 1000 operations) decreased from 23 in period A to 3.3 in period B (P<0.001) and 4 in period C (P<0.001). Of the 11 cases which occurred during periods B and C, only one actually received PPNM, and 10 occurred after acute as opposed to elective surgery (P<0.001). Point compliance with PPNM was 55% and 61% at 6 and 12 months. Vancomycin usage (defined daily doses) declined by 23%. Low level mupirocin resistance was found in 2.3% of SA isolates before PPNM and in 3.9%, 6.1%, 10% and 0% in subsequent periods (no strains had MICs >32 mg/L). Point prevalence nasal MRSA carriage decreased from 38% before PPNM to 23% immediately after, and 20%, 7%, 10% and 8% at 6 monthly intervals after PPNM. Conclusion: PPNM plus preoperative triclosan bathing is an effective control measure for MRSA orthopedic SSIs. Poor compliance with the protocol, particularly in acute cases, was highly associated with MRSA SSI.


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