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Reduction of Surgical-Site Infections in Cardiothoracic Surgery by Elimination of Nasal Carriage of Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Jan A.J.W. Kluytmans ,
Johan W. Mouton ,
Marjolein F.Q. VandenBergh ,
Marie-José A.A.J. Manders ,
Alexander P.W.M. Maat ,
Johan H.T. Wagenvoort ,
Marc F. Michel  and
Henri A. Verbrugh
Jan A.J.W. Kluytmans*
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Johan W. Mouton
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Marjolein F.Q. VandenBergh
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Marie-José A.A.J. Manders
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Alexander P.W.M. Maat
Affiliation:
Department of Thoracic Surgery, University Hospital Rotterdam, Dijkzigt, The Netherlands
Johan H.T. Wagenvoort
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Marc F. Michel
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
Henri A. Verbrugh
Affiliation:
Department of Clinical Microbiology, University Hospital Rotterdam, Dijkzigt, The Netherlands
*
Department of Clinical Microbiology, Ignatius Hospital Breda, PO Box 90158, 4800 RK Breda, The Netherlands
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Abstract

Objective:

To test the hypothesis that perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment reduces the surgical-site infection (SSI) rate in cardiothoracic surgery.

Design:

Unblinded intervention trial with historical controls.

Setting:

A university hospital, tertiary referral center for cardiothoracic surgery.

Patients:

Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (historical control group), and between March 1, 1991, and August 1, 1992 (intervention group).

Results:

The historical control group consisted of 928 patients and the intervention group of 868, of whom 752 actually were treated. The 116 patients who were unintentionally not treated were considered as a concurrent control group. In the intention-to-treat analysis, a significant reduction in SSI rate was observed after the intervention (historical-control group 7.3% and intervention group 2.8%; P<.0001). The SSI rate in the concurrent control group was significantly higher than in the treated group (7.8% and 2.0%, respectively; P=.0023). Resistance of S aureus to mupirocin was not observed.

Conclusion:

The results of this study indicate that perioperative elimination of nasal carriage using mupirocin nasal ointment significantly reduces the SSI rate in cardiothoracic surgery patients and warrants a prospective, randomized, placebo-controlled efficacy trial. This preventive measure may be beneficial in other categories of surgical patients as well.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 12 , December 1996 , pp. 780 - 785
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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