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Long-term Efficacy of Intranasal Mupirocin OintmentA Prospective Cohort Study of Staphylococcus aureus Carriage
Bradley N. Doebbeling, MD, MS;
David R. Reagan, MD, PhD;
Michael A. Pfaller, MD;
Alison K. Houston;
Richard J. Hollis, MA;
Richard P. Wenzel, MD, MSc
Arch Intern Med. 1994;154(13):1505-1508.
Abstract
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Background
We investigated the long-term effect of a single 5-day application of intranasal mupirocin calcium ointment on Staphylococcus aureus nasal and hand colonization. The subjects were 68 healthy volunteers who were health care workers with stable S aureus nasal carriage and who had participated in a randomized, double-blind, placebo-controlled clinical trial of intranasal mupirocin ointment.
Methods
A 1-year prospective cohort study of S aureus nasal carriers after treatment with active drug or placebo was performed. Cultures were obtained from all subjects 6 and 12 months after therapy. All subjects returned for the 6-month visit; 63 (93%) were examined at 1 year. The major outcome measure was the relative proportion of any S aureus cultured at either site at 6 and 12 months. The S aureus isolates were typed by restriction endonuclease analysis of plasmid DNA and by antibiotic susceptibility tests; the similarity of nasal and hand isolate "fingerprints" was compared.
Results
At 6 months, nasal carriage was 48% in the treatment group vs 72% in controls (relative risk, 0.68; 95% confidence interval, 0.45 to 1.02; P=.054); at 1 year, nasal carriage was 53% vs 76%, respectively (relative risk, 0.70; 95% confidence interval, 0.48 to 1.02; P=.056). Hand carriage at 6 months was significantly reduced among mupirocin recipients relative to controls (15% and 48%; P=.04, adjusted for the baseline rate of hand carriage). Thirty-six percent of treated subjects were recolonized in the nares with a new strain at 1 year, whereas 34% had reisolation of the original strain after initially negative posttherapy cultures. During the year of follow-up, hand carriage was observed at least once in two thirds of the subjects. Nearly all of the hand isolates (87%) exactly matched the subjects' coincident nasal plasmid fingerprint and antibiogram type.
Conclusions
A single brief treatment course of intranasal mupirocin was effective in reducing nasal S aureus carriage for up to 1 year. When S aureus was recovered after nasal decolonization, the new isolate was as likely to represent colonization with a new strain as reisolation of the original strain. Staphylococcus aureus hand carriage was significantly decreased 6 months after therapy, further implicating the nares as the primary reservoir site for hand carriage.
(Arch Intern Med. 1994;154:1505-1508)
Author Affiliations
From the University of Iowa College of Medicine (Drs Doebbeling, Reagan, Pfaller, and Wenzel, Ms Houston, and Mr Hollis); Department of Veterans Affairs Medical Center (Dr Doebbeling); and University of Iowa Hospitals and Clinics, Iowa City (Drs Pfaller and Wenzel). Dr Reagan is now with James H. Quillen College of Medicine, East Tennessee State University, Johnson City.
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