Prevention of Staphylococcus aureus burn wound colonization by nasal mupirocin

• Published in: Burns Vol. 34; no. 6; pp. 835 - 839
• Main Authors: Kooistra-Smid, A.M.D, van Zanten, E, Ott, A, van Dijk, S.R, Beerthuizen, G.I.J.M, Vogels, W.H.M, van Belkum, A, Verbrugh, H.A
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2008; Elsevier Science
• Subjects: Administration, Intranasal; Adult; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Burn wound colonization; Burns; Burns - complications; Burns - microbiology; Critical Care; Cross Infection - prevention & control; Drug Administration Routes; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Mupirocin - therapeutic use; Nasal Mucosa - microbiology; Nasal mupirocin; Nose - microbiology; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Staphylococcal Infections - prevention & control; Staphylococcal Infections - transmission; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Traumas. Diseases due to physical agents; Treatment Outcome; Staphylococcus aureus; Nasal mupirocin; Burn wound colonization; Skin disease; Mupirocin; Nasopharynx; Wound; Infection; Burn; Prevention; Antibiotic; Nose; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Antibacterial agent; Staphylococcal infection; Colonization
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2007.09.011

Abstract Background There are two important routes for the transmission of Staphylococcus aureus to the burn wound. In the endogenous route, patients naturally carrying S. aureus colonize their own wounds, whereas in the exogenous route burn wounds are cross-infected from other sources. In this study we evaluated the effect of blocking the endogenous route on S. aureus burn wound colonization by mupirocin application in the nose of patients at the time of admission. Methods From September 2000 to January 2002 all patients with burns admitted to a single dedicated Burn Centre received nasal mupirocin upon admission. This period was compared to two control periods (C1: July 1999 to July 2000 and C2: January 2002 to January 2003) for S. aureus burn wound colonization. The colonization risk was analysed, adjusting for confounding, with Cox proportional hazard regression. Results A total of 98 patients did not have S. aureus burn wound colonization at the time of admission and were, thus, considered at risk for S. aureus acquisition during their stay. As compared to C1, the relative risk of acquiring S. aureus in their wound was 0.48 (95% CI: 0.24–0.97) in the mupirocin period and 0.55 (95% CI: 0.28–1.1) during the C2 period. S. aureus nasal/pharyngeal colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2–4.2). Conclusion Nasal mupirocin may contribute to risk reduction of S. aureus wound colonization in patients with burns.