The NOSE study (nasal ointment for Staphylococcus aureus eradication): a randomized controlled trial of monthly mupirocin in HIV-infected individuals

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 55; no. 4; p. 466
• Main Authors: Gordon, Rachel J, Chez, Nancy, Jia, Haomiao, Zeller, Barbara, Sobieszczyk, Magda, Brennan, Caitlin, Hisert, Katherine B, Lee, Mei-Ho, Vavagiakis, Peter, Lowy, Franklin D
• Format: Journal Article
• Language: English
• Published: United States 01.12.2010
• Subjects: Administration, Intranasal; Adult; AIDS-Related Opportunistic Infections - drug therapy; Anti-Bacterial Agents - administration & dosage; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Methicillin Resistance; Mupirocin - administration & dosage; Ointments; Staphylococcal Skin Infections - drug therapy; Staphylococcus aureus - drug effects; Treatment Outcome
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0b013e3181ec2a68

HIV-positive patients at HELP/PSI, Inc, an in-patient drug rehabilitation center, had a high baseline prevalence of Staphylococcus aureus colonization (49%) and incidence of infection (17%) in a previous year-long study. A randomized, double-blinded, placebo-controlled study was conducted to determine whether repeated nasal application of mupirocin ointment would decrease the odds of S. aureus nasal colonization in 100 HELP/PSI patients over an 8-month period. A 5-day course of study drug was given monthly, and colonization was assessed at baseline and 1 month after each treatment. S. aureus infection was a secondary outcome. In repeated-measures analysis, mupirocin reduced the odds of monthly S. aureus nasal colonization by 83% compared with placebo [adjusted odds ratio (ORadj) = 0.17; P < 0.0001]. Subjects colonized at study entry had a 91% reduction in subsequent colonization (ORadj = 0.09; P < 0.0001). Mupirocin also suppressed S. aureus colonization in subjects not colonized at baseline (ORadj = 0.23; P = 0.006). There was no difference in infection rates between the mupirocin and placebo groups (hazard ratio = 0.49, P = 0.29). Monthly application of nasal mupirocin significantly decreased S. aureus colonization in HIV patients in residential drug rehabilitation. Monthly mupirocin application has a potential role in long-term care settings or in HIV-positive patients with high rates of S. aureus colonization and infection.