Prevention of Staphylococcus aureus burn wound colonization by nasal mupirocin
Introduction
Patients with burns are at a high risk of contracting nosocomial pathogens and infection. Several studies have shown that the rate of burn wound colonization with Staphylococcus aureus varies considerably [1], [2], [3], [4], [5]. The risk of colonization is related to the total burned surface area (TBSA), the age of the patient, nasal and pharyngeal S. aureus carriage of patients as well as of their health care workers, and the type of care provided by the Burn Centre. Colonization with S. aureus has been associated with delayed wound healing, increased need for surgical interventions and prolonged length of stay at the centre [3], [6]. Transmission of S. aureus occurs often, both between patients and between patients and care takers [7]. Part of S. aureus wound colonizations in patients is of endogenous origin, i.e. their wounds become colonized by the S. aureus strain already present in the patients’ nose or throat at the time of admission [8], [9], [10], [11]. By eliminating nasal carriage, nasal mupirocin could prevent endogenous S. aureus wound colonization.
Topical mupirocin has been widely used to treat nasal S. aureus carriage, particularly during outbreaks of methicillin resistant strains (MRSA) [12], [13]. Mupirocin prophylaxis has been shown to reduce the rate of nasal carriage, and hence, clinical infection in surgical and dialysis patients and in human immunodeficiency virus (HIV) disease [14], [15], [16], [17]. In a single centre study Mackie et al. [18] found a significant reduction in S. aureus wound colonization when using nasal mupirocin combined with selective decontamination of the digestive tract in patients with more than 30% TBSA. Potentially, mupirocin could be used to prevent endogenous colonization of burn wounds. However, the efficacy of standard mupirocin prophylaxis in a Burn Centre has not yet been established.
The aim of the present investigation was to evaluate the effect of a short course of nasal mupirocin on the incidence of S. aureus burn wound colonization.
Section snippets
Setting
The study was performed at the Burn Centre of the Martini Hospital, Groningen, The Netherlands. The Burn Centre is a closed unit including a dedicated operating theatre. It consists of four rooms with two beds each and two single intensive treatment (IT) rooms, potentially accommodating a total of 10 patients. Throughout the centre an air-flow with positive pressure is maintained and, additionally, each IT-room has its own laminar down-flow with positive air pressure.
At the Burn Centre a
Results
During the mupirocin period 42 patients were included versus 39 and 32 patients during control periods C1 and C2, respectively. Table 1 shows the characteristics of analysed patients. Both TBSA and duration of hospital stay were significantly higher/longer during the mupirocin period as compared to control periods. These differences are mainly due to the admission of many seriously burned young patients that survived a disastrous fire on New Year's eve, 2001, in a café in Volendam [19]. Also S.
Discussion
This study showed that the risk of S. aureus burn wound colonization was reduced in the period during which a short course of nasal mupirocin was administered to all patients upon admission to a Burn Centre. We also confirmed that S. aureus nasopharyngeal colonization significantly increased the risk of burn wound colonization, which supports the importance of the endogenous infection route. Interestingly we found that in the second control period following this intervention period, the
Acknowledgements
We thank the Dutch Burn Association for financial support (project number 02.10), and Dr. Marianne Nieuwenhuis for critical reading of this manuscript.
References (31)
- et al.
Influence of a changed care environment on bacterial colonization of burn wounds
Burns
(1995) - et al.
Methicillin-resistant Staphylococcus aureus in burns patients why all the fuss?
Burns
(1998) - et al.
Predominance of staphylococcal organisms in infections occurring in a burns intensive care unit
Burns
(1992) - et al.
Microbial colonization of large wounds
Burns
(1995) - et al.
Colonization of burns and the duration of hospital stay of severely burned patients
J Hosp Infect
(1992) - et al.
The cafe fire on New Year's Eve in Volendam, The Netherlands: description of events
Burns
(2005) MRSA patients: proven methods to treat colonization and infection
J Hosp Infect
(2001)- et al.
A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit
J Hosp Infect
(2002) - et al.
Determinants of Staphylococcus aureus nasal carriage
Neth J Med
(2001) - et al.
Molecular epidemiology of Staphylococcus aureus colonization in a burn centre
Burns
(2004)
Attempts to control clothes-borne infection in a burn unit, clothing routines in clinical use and the epidemiology of cross-colonization
J Hyg (Lond)
Staff carriage of epidemic methicillin-resistant Staphylococcus aureus
J Clin Microbiol
Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis
N Engl J Med
Nasal carriage of and infection with Staphylococcus aureus in HIV-infected patients
Ann Intern Med
Nasal carriage as a source of Staphylococcus aureus bacteremia
N Engl J Med
Cited by (9)
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2020, Comprehensive Dermatologic Drug Therapy, Fourth EditionThe evaluation of nasal mupirocin to prevent Staphylococcus aureus burn wound colonization in routine clinical practice
2014, BurnsCitation Excerpt :This supports the important role of nasal carriage in burn wound colonization and thus the presence of endogenous transmission. The elimination rate of 83% that we found for S. aureus nasal carriers by application of nasal mupirocin, is similar to that reported in previous studies [10,16]. Despite this high elimination rate, we did not find a reduction in burn wound colonization rate during the mupirocin period.
Topical antibacterial agents
2012, Comprehensive Dermatologic Drug Therapy: Expert Consult - Online and PrintTreatment of infection in burns
2012, Total Burn Care: Fourth EditionAn outbreak of a Multiresistant Methicillin-Susceptible Staphylococcus aureus (MR-MSSA) strain in a Burn Centre: The importance of routine molecular typing
2011, BurnsCitation Excerpt :In a study by Mackie et al. a significant reduction in S. aureus wound colonization was found when using nasal mupirocin combined with selective decontamination of the digestive tract in patients with more than 30% TBSA [17]. Kooistra-Smid et al. showed that the risk of S.aureus burn wound colonization was reduced in a period in which a short course of nasal mupirocin was administered to all patients upon admission to a burn centre [18]. They also found that S. aureus colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2–4.2), which supports the importance of the endogenous infection route.
Topical Antimicrobial Agents for Burn Wounds
2009, Clinics in Plastic SurgeryCitation Excerpt :The agent is also used intranasally to treat carriers of MRSA. Some burn units are using intranasal mupiricin to reduce the risk for Staphlococcus infections.15,16 There is a potential for developing resistance to the antimicrobial agent, so it should not be used for more than 10 days.