Mupirocin Reduced S. aureus Infections in Nonsurgical Settings



PHILADELPHIA, PA—Mupirocin decreased the risk of Staphylococcus aureus infection among both dialysis and adult ICU patients in a meta-analysis of 37 studies, reported Rajeshwari Nair, MBBS, MPH, and colleagues, from the University of Iowa, at IDWeek 2014.

A total of 12,597 studies published up to June 2013 on the effectiveness of mupirocin in healthcare settings, were identified from systematic searches of PubMed, Cochrane Library Databases, Scopus, Web of Science, and ClinicalTrials.gov. Thirty-seven studies were included in the final systematic review. Data were analyzed using a random effects model with inverse variance methodology, and odds ratios were pooled (pOR).

Data analysis showed that mupirocin reduced the odds of infection by 50% in all admission settings (pOR=50, 95%CI 0.44, 0.58), and was relatively more protective in dialysis patients compared to non-dialysis such as ICU and other hospital admissions (pOR=0.41, 95%CI 0.36, 0.48). In addition, universal decolonization was more effective than targeted.

Mupirocin decolonization was effective at preventing exit-site infections (pOR=0.41, 95%CI 0.33, 0.52), bacteremia among hemodialysis patients (pOR=0.42, 95%CI 0.32, 0.54), and at preventing Methicillin-resistant S. aureus (MRSA) infections among ICU patients (pOR=0.58, 95%CI 0.41, 0.84). Subgroups were homogeneous by type of infection (p=0.35, I2=9.2%) and study design (p=0.91, I2=0%).

Limitations of this study included a significant degree of heterogeneity among studies included in the meta-analysis (I2=82%), and potential publication bias.

“Mupirocin decolonization regardless of combination agents and decolonization site was protective against hospital acquired infections,” concluded Dr. Nair, and suggested “additional studies are warranted in long-term care facilities and pediatric settings”.
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