Deep S. Aureus Surgical Site Infections Lower with Povidone-Iodine vs. Mupirocin

SAN DIEGO, CAClinicians should consider nasal povidone-iodine as an alternative to nasal mupirocin ointment to reduce risk of deep Staphylococcus aureus surgical site infections (SSI) following arthroplasty and spine fusion surgery, an open-label, randomized trial reported at IDWeek 2012.

The use of nasal mupirocin with topical chlorhexidine gluconate prior to surgery has been shown to reduce the risk of S. aureus SSIs. The efficacy of preoperative nasal povidone iodine with topical chlorhexidine gluconate in reducing the risk of S. aureus SSIs has not been thoroughly established.

Michael S. Phillips, MD, from the New York University School of Medicine and New York University Langone Medical Center, and colleagues compared SSIs in patients who received two applications of topical chlorhexidine gluconate (CHG) along with either one application of nasal povidone-iodine administered within 2 hours of incision or nasal mupirocin ointment 2% applied twice daily for 5 days prior to surgery in an open-label, randomized trial. Povidone-iodine was studied due to its potential to be used as an alternative, less expensive therapy for patients.

The primary endpoint was deep S. aureus SSIs at 3 months' follow-up, following the Centers for Disease Control and Prevention's National Healthcare Safety Network case definition as determined by infection control practitioners blinded to study enrollment and use of study medication. Secondary endpoints included superficial S. aureus SSI, deep SSI due to any pathogen and adverse drug reactions.

In a modified intent-to-treat analysis, deep S. aureus SSIs developed after 1 of 887 surgeries in the povidone-iodine arm compared with 5 of 879 surgeries in the mupirocin arm (P=0.1) One superficial S. aureus SSI was detected in the povidone-iodine group, while none was observed in the mupirocin group.

“Deep SSI due to any pathogen developed after 6 surgeries in the povidone-iodine group and 14 surgeries in the mupirocin group (P=0.07),” Dr. Phillips reported.

Per protocol analysis found deep S. aureus SSI emerged in 0 of 776 surgeries in the povidone-iodine group and 5 of 761 surgeries in the mupirocin group (P=0.05). Preoperative S. aureus colonization status was associated with S. aureus SSI (P=0.002).

Adverse events—due to either study drug or CHG—were observed in 3% of povidone-iodine patients and in 10% of mupirocin patients (P<0.001).