Long-term Efficacy of Intranasal Mupirocin Ointment

A Prospective Cohort Study of Staphylococcus aureus Carriage

Bradley Doebbeling, David R. Reagan, Michael A. Pfaller, Alison K. Houston, Richard J. Hollis, Richard P. Wenzel

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1505-1508
Number of pages4
JournalArchives of Internal Medicine
Volume154
Issue number13
DOIs
StatePublished - Jul 11 1994
Externally publishedYes

Fingerprint

Mupirocin
Ointments
Nose
Staphylococcus aureus
Cohort Studies
Prospective Studies
Hand
Dermatoglyphics
Plasmids
Placebos
Confidence Intervals
DNA Restriction Enzymes
Controlled Clinical Trials
Microbial Sensitivity Tests
Therapeutics
Healthy Volunteers
Outcome Assessment (Health Care)
Anti-Bacterial Agents
Calcium
Delivery of Health Care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Long-term Efficacy of Intranasal Mupirocin Ointment : A Prospective Cohort Study of Staphylococcus aureus Carriage. / Doebbeling, Bradley; Reagan, David R.; Pfaller, Michael A.; Houston, Alison K.; Hollis, Richard J.; Wenzel, Richard P.

In: Archives of Internal Medicine, Vol. 154, No. 13, 11.07.1994, p. 1505-1508.

Research output: Contribution to journalArticle

Doebbeling, Bradley ; Reagan, David R. ; Pfaller, Michael A. ; Houston, Alison K. ; Hollis, Richard J. ; Wenzel, Richard P. / Long-term Efficacy of Intranasal Mupirocin Ointment : A Prospective Cohort Study of Staphylococcus aureus Carriage. In: Archives of Internal Medicine. 1994 ; Vol. 154, No. 13. pp. 1505-1508.
@article{518b6ab5549743ddb43cebb15c9d2060,
title = "Long-term Efficacy of Intranasal Mupirocin Ointment: A Prospective Cohort Study of Staphylococcus aureus Carriage",
abstract = "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.",
author = "Bradley Doebbeling and Reagan, {David R.} and Pfaller, {Michael A.} and Houston, {Alison K.} and Hollis, {Richard J.} and Wenzel, {Richard P.}",
year = "1994",
month = "7",
day = "11",
doi = "10.1001/archinte.1994.00420130101013",
language = "English (US)",
volume = "154",
pages = "1505--1508",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "13",

}

TY - JOUR

T1 - Long-term Efficacy of Intranasal Mupirocin Ointment

T2 - A Prospective Cohort Study of Staphylococcus aureus Carriage

AU - Doebbeling, Bradley

AU - Reagan, David R.

AU - Pfaller, Michael A.

AU - Houston, Alison K.

AU - Hollis, Richard J.

AU - Wenzel, Richard P.

PY - 1994/7/11

Y1 - 1994/7/11

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0028290889&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028290889&partnerID=8YFLogxK

U2 - 10.1001/archinte.1994.00420130101013

DO - 10.1001/archinte.1994.00420130101013

M3 - Article

VL - 154

SP - 1505

EP - 1508

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 13

ER -