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Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers

  1. Miranda van Rijen1,*,
  2. Marc Bonten2,
  3. Richard Wenzel3,
  4. Jan Kluytmans1

Editorial Group: Cochrane Wounds Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 26 SEP 2010

DOI: 10.1002/14651858.CD006216.pub2


How to Cite

van Rijen M, Bonten M, Wenzel R, Kluytmans J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006216. DOI: 10.1002/14651858.CD006216.pub2.

Author Information

  1. 1

    Amphia Hospital Breda, Laboratory for Microbiology and Infection Control, Breda, Netherlands

  2. 2

    University Medical Center Utrecht, Department of Internal Medicine and Infectious Diseases, Utrecht, Netherlands

  3. 3

    Virginia Commonwealth University, Department of Internal Medicine, Richmond, Virginia, USA

*Miranda van Rijen, Laboratory for Microbiology and Infection Control, Amphia Hospital Breda, PO Box 90158, Breda, 4800 RK, Netherlands. Mvrijen@amphia.nl.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008

SEARCH

 
Characteristics of included studies [ordered by study ID]
Boelaert 1989

MethodsDouble-blind, randomised controlled trial


ParticipantsHemodialysis patients. All carriers. Mupirocin: 17. Placebo: 18. No significant difference between both groups.


InterventionsMupirocin or placebo. Thrice daily for 2 weeks and subsequent 3 times weekly for a total of 9 months.


OutcomesS. aureus infection rate
Mortality
Adverse events


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskUnclear

Blinding?
participants
Low risk

Blinding?
outcome assessor
Low risk

Intention to treatLow risknot reported but confirmed

Loss to follow upLow riskMupirocin:41 Placebo:17

Garcia 2003

MethodsRandomised, prospective trial


ParticipantsCardiothoracic patients. Both carriers and non-carriers. Mupirocin: 31 carriers, Placebo: 34 carriers. No significant difference between both groups.


InterventionsMupirocin twice daily for 5 days. Controls received no treatment.


OutcomesS. aureus infection rate.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskInadequate

Blinding?
participants
High risk

Blinding?
investigator
High risk

Intention to treatLow risknot reported but confirmed by author

Loss to follow upLow riskMupirocin:13 Control:15

Harbarth 1999

MethodsDouble-blind, randomised controlled trial


ParticipantsPatients colonized with MRSA. Mupirocin: 48 Placebo: 50. No significant difference between both groups.


InterventionsMupirocin or placebo. Twice daily for 5 days.


OutcomesS. aureus infection rate.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskUnclear

Blinding?
participants
Low risk

Blinding?
investigator
Low risk

Blinding?
outcome assessor
Low risk

Blinding?
data analysis
Low risk

Intention to treatLow riskreported and confirmed

Loss to follow upHigh risk

Kalmeijer 2002

MethodsDouble-blind, randomised controlled trial


ParticipantsOrthopedic surgery patients. Both carriers and non-carriers. Mupirocin: 95 carriers. Placebo: 86 carriers. No significant difference between both groups.


InterventionsMupirocin or placebo. Twice daily from the day of admission (day before surgery) to the hospital until the day of surgery.


OutcomesS. aureus infection rate.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskAdequate

Blinding?
participants
Low risk

Blinding?
investigator
Low risk

Blinding?
outcome assessor
Low risk

Blinding?
data analysis
Low risk

Intention to treatLow riskreported and confirmed

Loss to follow upHigh risk

Konvalinka 2006

MethodsDouble-blind, randomised controlled trial


ParticipantsElective cardiac surgery patients. All carriers. Mupirocin: 130. Placebo: 127. Only COPD was more prevalent in the mupirocin group (p<0.01)


InterventionsMupirocin or placebo. Twice daily for 7 days, before surgery.


OutcomesS. aureus infection rate. Mortality. Adverse events. Infection rate caused by other micro-organisms than S. aureus.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskAdequate

Blinding?
participants
Low risk

Blinding?
investigator
Low risk

Blinding?
outcome assessor
Low risk

Blinding?
data analysis
Low risk

Intention to treatLow riskreported and confirmed

Loss to follow upHigh risk

Mup Study Group 1996

MethodsDouble-blind, randomised controlled trial


ParticipantsCAPD patients. All carriers. Mupirocin: 134. Placebo: 133. No significant difference between both groups.


InterventionsMupirocin or placebo. Twice daily for 5 days every 4 weeks, for maximal 18 months.


OutcomesS. aureus infection rate. Mortality. Adverse events. Infection rate caused by other micro-organisms than S. aureus.


NotesThis study was sponsored by the manufacturers of mupirocin (SmithKline Beecham, Baxter Health Care)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskUnclear

Blinding?
participants
Low risk

Blinding?
outcome assessor
Low risk

Intention to treatLow riskreported and confirmed

Loss to follow upLow riskMupirocin:1 Placebo:1

Perl 2002

MethodsDouble-blind, randomised controlled trial


ParticipantsGeneral, gynaecologic, neurologic and cardiothoracic.
patients. Both carriers and non-carriers. Mupirocin: 430 carriers. Placebo: 439 carriers. Patients that received placebo were more likely to have had renal disease (p=0.04).


InterventionsMupirocin or placebo. Twice daily for up to 5 days, before the operation.


OutcomesS. aureus infection rate. Mortality. Adverse events. Infection rate caused by other micro-organisms than S. aureus.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskAdequate

Blinding?
participants
Low risk

Blinding?
investigator
Low risk

Blinding?
outcome assessor
Low risk

Blinding?
data analysis
Low risk

Intention to treatLow riskreported and confirmed

Loss to follow upLow riskMupirocin 10.4 Placebo 13.2

Pérez-Fontan 1992

MethodsRandomised, prospective trial.


ParticipantsCAPD patients. All carriers. Mupirocin: 11. Neomycin: 8. No significant difference between both groups.


InterventionsMupirocin or Neomycin. Mupirocin thrice daily for 7 days.
Neomycin sulphate thrice daily for 7 days.


OutcomesS. aureus infection rate. Adverse events. Infection rate caused by other micro-organisms than S. aureus.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskUnclear

Wertheim 2004b

MethodsDouble-blind, randomised controlled trial


ParticipantsNonsurgical patients. All carriers. Mupirocin: 793. Placebo: 809. No significant difference between both groups.


InterventionsMupirocin or placebo. Twice daily for 5 days, started 1 to 3 days after admission.


OutcomesS. aureus infection rate. Time to infection. Mortality. Adverse events.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskAdequate

Blinding?
participants
Low risk

Blinding?
investigator
Low risk

Blinding?
outcome assessor
Low risk

Blinding?
data analysis
Low risk

Intention to treatLow riskreported and confirmed

Loss to follow upLow riskMupirocin: 9.7 Placebo:8.3

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Critchley 2006Not a trial.

Di Filippo 1999No data about carriers. Author could not be contacted for additional information.

Klaus 2002This was an abstract on the 5th European Peritoneal Dialysis Meeting in Brussels, Belgium, 4-7 May 2002. Family members of CAPD patients with nasal carriage were treated with mupirocin or placebo. It is unclear whether patients with nasal carriage were treated with mupirocin and how many carriers in both treatment groups (mupirocin/placebo) developed an infection caused by S. aureus. This abstract has not resulted in a paper yet and the author could not be contacted for additional information.

Leigh 1993Not health-care related.

Martin 1999No description of infections. Only data about eradication.

Mody 2003Not health-care related.

Niwa 1999No data about carriers. Author could not be contacted for additional information.

Raz 1996Not health-care related.

Simor 2007Combination of mupirocin treatment with oral antibiotics.

Sit 2007No data about carriers. Author contacted for additional information.

Suzuki 2003No data about carriers. Author contacted for additional information, but no reply was received.

Wasielewski 2003Not a trial. Describes the results of the trial by Perl et al.

 
Comparison 1. Nosocomial S. aureus infections among patients with S. aureus nasal carriage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Nosocomial S. aureus infection83374Risk Ratio (M-H, Fixed, 95% CI)0.55 [0.43, 0.70]

 2 Nosocomial S. aureus infection (High quality studies)42909Risk Ratio (M-H, Fixed, 95% CI)0.69 [0.47, 1.00]

 
Comparison 2. Nosocomial S. aureus infections among surgical patients with S. aureus nasal carriage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Nosocomial S. aureus infection41372Risk Ratio (M-H, Fixed, 95% CI)0.55 [0.34, 0.88]

 2 Nosocomial S. aureus infection (exclude Garcia)31307Risk Ratio (M-H, Fixed, 95% CI)0.56 [0.34, 0.91]

 3 Nosocomial S. aureus surgical site infection41374Risk Ratio (M-H, Fixed, 95% CI)0.63 [0.38, 1.04]

 
Comparison 3. Nosocomial S. aureus infections among dialysis patients with S. aureus nasal carriage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Nosocomial S. aureus infections2302Risk Ratio (M-H, Fixed, 95% CI)0.44 [0.32, 0.62]

 
Comparison 4. Nosocomial S. aureus infections among CAPD patients: a comparison of mupirocin to neomycin

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Nosocomial S. aureus infections122Risk Ratio (M-H, Fixed, 95% CI)0.42 [0.04, 3.95]

 
Comparison 5. Mortality among patients with S. aureus nasal carriage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Mortality42161Risk Ratio (M-H, Fixed, 95% CI)0.91 [0.64, 1.31]

 
Comparison 6. Infection rate caused by other micro-organisms than S. aureus: mupirocin compared with control

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Infection rate caused by other micro-organisms than S. aureus31393Risk Ratio (M-H, Fixed, 95% CI)1.38 [1.11, 1.72]

 2 Infection rate caused by other gram-positive micro-organisms than S. aureus2148Risk Ratio (M-H, Fixed, 95% CI)0.88 [0.55, 1.41]

 3 Infection rate caused by gram-negative micro-organisms2148Risk Ratio (M-H, Fixed, 95% CI)1.65 [0.78, 3.47]

 
Comparison 7. Infection rate caused by other micro-organisms than S. aureus: a comparison of mupirocin to neomycin

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Infection rate caused by other micro-organisms than S. aureus122Risk Ratio (M-H, Fixed, 95% CI)1.33 [0.64, 2.79]