Prophylactic mupirocin could reduce orthopedic wound infections: 1044 patients treated with mupirocin compared with 1260 historical controls

Abstract

We analyzed the effect of perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment on the reduction of the postoperative wound infection rate in orthopedics. In an unblinded intervention trial, we compared 1044 patients treated with mupirocin (intervention group) with 1260 historical controls (control group). From each group a random sample of 50 patients was taken. Risk factors were analyzed in these random samples and we found it unlikely that different distributions of risk factors might have influenced the results. The wound infection rates were 14/1044 in the intervention group and 34/1260 in the control group (p = 0.02). The rates of wound infections caused by S. aureus were subsequently 7/1044 and 14/1260 (p = 0.3). On checking the data we found that prophylaxis had unintentionally not been given to 172 patients in the intervention group. Correction of the data gave a comparable total infection rate, but a further reduced infection rate by S. aureus. Our findings suggest that prophylactic treatment with mupirocin in orthopedic surgery can reduce the infection rate.